SONOMA MOUNTAIN REPEATER SOCIETY
$15.00 Donations Welcome	P.O. BOX 176	PLEASE PRINT
	PETALUMA, CA 94953-0176

 
 

NAME:	CALL:		EXP DATE:
OTHER FAMILY MEMBER:	CALL:		EXP DATE:
ADDRESS:	APT#:
CITY:	ZIP:
HOME TELEPHONE (       )	LISTED		UNLISTED
WORK TELEPHONE (      )	FAX # (      )		PAGER #
E-MAIL :	LISTED		UNLISTED

PLEASE INDICATE BELOW:  

NEW APPLICATION		ARRL MEMBER
RENEWAL, NO CHANGES		ARRL LIFE MEMBER		LICENSE COPY ON FILE
RENEWAL, WITH CHANGES

 

MAKE CHECKS PAYABLE TO S.M.R.S	OFFICIAL USE ONLY
PLEASE WRITE CALL SIGN(S) ON CHECK	S#
PLEASE WRITE "FOR DEPOSIT ONLY" ON BACK OF CHECK	DT
NOTE:	CH
FAX AND PAGER NUMBERS WILL NOT BE PUBLISHED.	CK
NINE DIGIT ZIP CODE NEEDED.	AT
	M#

    CHECK #______________ DATE ____/____/____ AMOUNT________________