Mark category:

 

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  All information provided in this section will not be published to anyone except RACES coordinator.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