Request for Username and Password
NOTICE: This is only for Citrus Belt Amateur Radio Club Members
Please fill in all the information below. All Information is Required
First Name
Last Name
Call Sign
Email Address (Example: email @ somedomain.com)
Mailing Address
Mailing City State Zip
Telephone Number (Example: (123) 456-7890)
Requested Password (between 6 and 11 characters)
The following information may be found on your club issued membership card
Membership Expiration Date (Example: MM/YYYY)
Are you an ACS Member? No Yes
Are you a Board Member? No Yes