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New Member      Text Box:   Renewal    Text Box:  Family membership / renewal


Text Box:   Information update Text Box:  donation    Text Box:  Other


Amount enclosed: ___________   Designation of donation __________________


Dues are $20 per year from April to April


Name:__________________________  Call(s) ___________________________


Address: ___________________________________ City: __________________


State: ______  Zip: __________  Class:  Tech   Text Box: Gen  Adv  Extra


Email for Newsletter: ________________________________


Phone: ____________________ Text Box:  Listed   Text Box:  unlisted


ARRL member:Text Box:    WITF member:Text Box:


EMCOMM volunteer registration.  All information provided in this section will not be published to anyone except RACES coordinator. 


Work including extension : ___________________________


Cell   _____________________


Daytime email _____________________________________