Name_________________________ Callsign_____________ Class______________
Name_________________________ Callsign_____________ Class______________
Name_________________________ Callsign_____________ Class______________
Address________________________________________________________________
City, State/Province___________________________________________________
Country, Zip/Postal Code_______________________________________________
Phone Number___________________________________________________________
E-Mail Address_________________________________________________________
Make of Motorcycle_____________________________________________________
Make of Ham Radio on Motorcycle________________________________________
Do you have HF capabilities (mobile or base)?__________________________
How did you first hear about MARC?_____________________________________
_______________________________________________________________________
Please Circle One:
Yes / No Is this a NEW donation application? [NO indicates renewal.]
Yes / No Do you have a C.B. Radio on your M/C?
Yes / No Do you want your address on the Club Roster?
Yes / No Do you want your phone number on the Club Roster?
Yes / No Do you want your E-Mail Address on the Club Roster?
Web / Mail Do you want to receive the newsletter via the web or mail?
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