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Subject : (please choose) 

Last Name:    First Name:   MI:   
Call Sign:    License Class:    
Date of Birth:   
Address:    City:    State:   
Country:    Zip Code:   
Home Phone:    Work Phone:   
Email Address:   
Home Page Address:   
Other Club Affiliations:   
                               Membership Donation:    $30.00   

    I have read and agree with the PHILIPPINE CIVIL COMMUNICATIONS (PHILCCOM) Constitution and By-Laws and with the provisions of the FCC Part 97 Rules and Regulations dealing with the Amateur Radio Service.   
    Additionally, I have been briefed by the Membership Committee or his/her representative about the club repeater, IRLP, phone patch and operating procedure and fully understand it.   

Applicant's Signature:    Date:    

    Please send a copy of your Industry Canada / National Telecommunications Commission or FCC issued Amateur Radio License together with the applicable donation to the PHILCCOM address below.  Your application will be processed after receipt of both requirements.  If you have a scanned copy of your picture and you want it to be posted on the club Members' List, please email it to the webmaster at  A short write up of your background information will also be needed for the member's profile if so desired.  Thank you.   

10722 155 street, Edmonton Alberta, Canada  T5P2M6