RV Radio Network

Membership Application Form

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Name: _____________________________ Handle: _____________ Call: ____________

Spouse: ________________________ Call: ______________

Address: _______________________ City: ______________ State: ____ ZIP: ______

Phone: ( ) _________________ ARRL:(Yes)(No) Email _________________________

May we send your newsletters via email _____________

How did you hear about the RV Radio Network?________________________________________________________________________

________________________________________________________________________________

Signature: ________________________________

Roster and Newsletter Fee: $12.00 Initially, $10.00 Annually

Checks Only: Payable to "RV Radio Network"

New Members Send to: Jesse Knight, WB4PPW

3194 Pate Road

Snellville, GA 30079

Renewals Send to: Barb Dittlinger

P.O. Box 510

Benton, MO 63736

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