Please provide us with this information if you choose to make payment to
the Colorado QRP Club via PayPal. This information can be emailed to us 
at: paypal@cqc.org - please note that due to PayPal's high expense we ask 
that you only use PayPal for orders of $18 USD or more - For anything 
less we ask for a check or money order via surface mail - Thank you!

Or, you can send this form via surface mail to:

	Colorado QRP Club
	P.O. Box 17174
        Golden, Colorado
	80402-6019   USA

If this is a New Membership Please Check Here:_________
If this is a renewal, please place your membership number here:__________
(All membership numbers are listed at: http://www.cqc.org/cqcmems.htm) 


Callsign:___________________________
Name:_____________________________
Address:___________________________
City:______________________________
State:_____________________________  ZIP/Postal Code:_______________
Country:__________________________
email:__________________________


Additional family members are $2.00 USD each.
Please list each of their names and callsigns here:
(Each will receive their own membership number but
only one Low Down will be mailed to the above address)   
Name:_______________________________ Callsign:___________ 
Name:_______________________________ Callsign:___________ 
Name:_______________________________ Callsign:___________   


$6.00 USD U.S. membership for one year 
$8.00 USD DX (Foreign) membership for one year 
$2.00 USD for each additional family member at the same address 
$7.00 USD additional, each year, for Low Down hard copy via mail

I am enclosing payment for: 
Subscription/Renewal______________________ year(s). 
Merchandise (list items)___________________________________ 
Total USD Enclosed:____________________________

- - - - - -
 
The following information is optional, but would be helpful if you provided it: 

ARRL Member?  [ ]YES    [ ]NO 

Your Web Page URL: _____________________________________________________________ 

Home Phone: _________________     Business Phone:___________________  FAX: _________________ 

License Class: 
[ ]EXTRA    [ ]ADVANCED   [ ]GENERAL   [ ]TECHNICIAN PLUS 
   [ ]TECHNICIAN  [ ]NOVICE   [ ]FOREIGN   [ ]NONE 

Other QRP Club Memberships: ________________ 

Occupation: ________________________________ 

Are you...  [ ]Active in QRP?     [ ]Inactive?   [ ]New to QRP?      [ ]Interested in QRP? 
If Active, on what bands? _______________ 

QRP Interests: [ ]Operating  [ ]Technical  [ ]DX   [ ]Contests  [ ]Construction  [ ]Portable 
[ ]Mobile  [ ]VHF/UHF  [ ]QRPp  [ ]Digital  [ ]Antennas 

Other QRP Interests:  ________________ 
QRP Equipment you own/use: _________________________