First Name*

Last Name*

Address Line 1*

Address Line 2

City*

State*

Country*

Zip Code*

Home Phone*

Cell Phone

Email Address*

DOB (mm/yyyy)*

DOB needed for dues calculations.

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Call Sign*

License Class*

License Class

Technician General Extra Advanced

Years as Ham*

Net Control Experience

Net Control Experience

Yes No

Volunteer for Net Control

Volunteer for Net Control

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Service Branch*

  AAC AAF USA USAF USCG USMC USN Other Note: If "Other" is selected, please indicate your service branch in the Comments field.

Military Status*

  Active Reserve Retired Veteran Other Note: If "Other" is selected, please indicate your military status in the Comments field.

Rank*

Years of Service*

Job Type*

  Air Crew ATC Missile Crew Support Other Note: If "Other" is selected, please indicate your job type in the Comments field.

Comments

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