Fill Out the Form Below

Filling out the form below will submit your information, via E-Mail to the Membership Chairman.  Dues will still need to either be sent via U.S. Mail or PayPal.

If you prefer, here is a link to a printable application you can complete and mail.

Printable Application

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Name *

First

Last

Email *

Callsign

License Class

Year First Licensed

Street Address

City State Zip

Phone Number

Total Confirmed Countries

DXCC Level Attained

• Working on it
• DXCC (100 Countries)
• DXCC Honor Roll
• #1 DXCC Honor Roll

ARRL Member ?

• Yes
• No
• Life

OKDXA Application Type

• New Member
• Renewal

OKDXA Membership Type

• Regular Member
• Senior Member (Age 65 or older)
• Handicapped Member
• Family Member

Dues to be Paid

• $20.00 Regular Member
• $10.00 Senior Member (Age 65 or older)
• $10.00 Handicapped Member
• $ 5.00 Family Member
• Donate to OKDXA (Fill in amount below)
• Other (Fill in amount below)

Enter Amount only if Donating or Other

Method of Payment

• Check to be sent via US Mail
• PayPal
• Other

Comment or Message

Email *

Submit

-> If paying by check via U.S. Mail:

Mail Dues to: (payable to OKDXA)

Mark Chouinard – K5YAC
12510 N. 73rd E. Ave.
Collinsville, OK. 77021

-> If paying via PayPal:

Go to PayPal

Make your PayPal payment to: OKDXASSN@gmail.com
Be sure to provide your name and callsign with your payment