MEMBERSHIP APPLICATION

Click here for an Adobe Acrobat version of this form, which you can fill in on your computer, then print out and mail

 

Name: __________________________________________________________

 

Rank/Rate: ____________ Duty Status: ___________ ZUT NR: ____________

Date of Birth (mm/dd/yyyy): _____/_____/__________

 

If you have previous been issued a ZUT#, but don’t remember it, check here: _____________

 

If you have never been issued a ZUT#, check here: ______

 

Address: ________________________________________________________

 

City: _______________________________________  State: ____ ZIP_______

 

Fone: ___________________ E-Mail: ___________ Ham C/S: _____________

 

Qualifications: (List where and when you served as a CW operator for the Coast Guard)

 

 

I was referred for membership by: ____________________________________

 

Membership qualifications are simple: You must have been a Coast Guard CW operator. Initial membership is $30 for the year you joined, and includes an annual membership directory and a Comm-One newsletter subscription for the year you joined. Continued subscription to Comm-One is $30 a year, payable in January. Associate membership is offered to other professional and military CW operators at the same rates.

 

This completed application, along with a $30 check or money order made payable to Coast Guard CW Operators Association, should be mailed to:

 

COAST GUARD CW OPERATORS ASSOCIATION

ANDY SCHARF, CWO2(COMM), USCG-RET

2015 NW Taylor Street

Topeka, KS 66608-1940