MEMBERSHIP APPLICATION

SEND PROOF OF CURENT 1010 MEMBERSHIP WITH

 FEE AND APPLICATION OR THEY WILL BE RETURNED

               YOUR INFORMATION NEXT

CALL______________ NAME______________________

ADDRESS______________________________________

CITY_________________STATE____ PHONE________

ZIP__________________ COUNTRY________________

DATE OF BIRTH_ MONTH_____DAY______

1010 #___________________VP# __________

1010 EXP. DATE___________EMAIL_________________

   !!!   TO QUALIFY FOR MEMBERSHIP YOU NEED   !!!

ONE FM OR IQ OR SQ _________ CALL______________

MEMBER # ____________ CONTACT VALUE__________

OR SIX REGULAR OM MEMBERS.

 LIST ALL OTHER CONTACTS ON BACK OF FORM.

A COLOR CERTIFICATE IS ISSUED WITH EACH FULL PAID MEMBERSHIP: FEES ARE $ 5.00 FOR EACH CHAPTER (U.S.A) AND $ 7.00 FOR EACH CHAPTER (DX).

 TO JOIN BOTH IT IS $ 10.00 (U.S.A). AND $ 14.00 (DX).

 FOR A  NO COST, NO CERTIFICATE  MEMBERSHIP

 NEEDED IS THIS APPLICATION AND ONE S.A.S.E # 10 LEGAL SIZE ENVELOPE,  OR SEND EMAIL TO   k4drz@netzero.net, or contact me on air on 28.375

FOR ANY INFORMATION PLEASE SEND NOTE TO k4drz@netzero.net

         BELOW IS FOR YOUR RECORDS ONLY

 ?? DON'T FORGET TO INCLUDE APPLICATION WITH

MONEY  ORDER (OR CASH IF YOU LIKE ) ??

MONEY ORDER IS PAYABLE TO:  DONALD R. ZAK; SR.

IF NOT IT WILL BE RETURNED!!

MAIL TO:  DONALD R. ZAK; SR.

3011 W. WILDER AVE. TAMPA, FL.  33614-6759

THANK YOU FOR YOUR INTEREST AND TIME.

HAVING YOU AS A MEMBER WOULD BE A GREAT PLEASURE.

 FROM ALL THE MEMBERS  AND MYSELF.

GOD BLESS AND 73 

  DON K4DRZ

YOUR FRIEND IN AMATEUR RADIO