MEMBERSHIP APPLICATION Please send this completed form, your check payable to RMRL, and a copy of your amateur license to: RMRL Membership, P. O. Box 3821, Centennial, CO 80161-3821. (  ) Family membership (for all amateurs in a household) - $20.00 (  ) Youth Individual membership (for amateurs 15 years old or younger with parents who are         not RMRL members) - $5.00 Name ______________________________________ Callsign _____________ Are you a member of ARRL?      Y       N Family Members (Family membership only) Callsign ARRL Member? ______________________________ ___________ Y      N ______________________________ ___________ Y      N ______________________________ ___________ Y      N Birth Date (Youth Individual membership only) ___________ Address ____________________________________________ City __________________________ State ____ Zip _________ Home Phone (____) ______-______ Work Phone (____) ______-_______ E-Mail Address _________________________ (  ) Check if home phone may NOT be listed in the club roster (  ) Check if address may NOT be listed in the club roster May we contact you to help with club activities? (  ) Hamfest (  ) Picnic (  ) Annual Dinner (  ) Tower (  ) Newsletter (  ) Technical (  ) Net (  ) Miscellaneous ___________________

Application Instructions:
        Print this Web Page.
        Fill out the application
        Mail the application and your payment to:
                RMRL Membership, P.O. Box 3821, Centennial, CO  80161