In placing this application for family membership in CCCC, Inc., I agree to keep confidential all control codes and other data furnished to me by the club as confidential, in order to comply with and maintain security of “control” as required by the F.C.C.  I recognize the obligation of the club and the club Trustee to the F.C.C. and California State Corporations Codes. I agree to cooperate with the club Board of Directors and club Trustee in matters of operating policy in order to maintain the integrity of the club station license. I agree to abide by the constitution and bylaws of the corporation. I understand club membership ends automatically with license expiration. I understand the license suspension or revocation by the FCC will result in cancellation of club membership with no refund of moneys paid to the club.   

I have read and agree.    Please check box.

Signed   Date

Family Member Signature

Signed   Date

Member Signature (For Youth membership responsible adult must also sign.

 *Return check fees apply