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Membership Application

If you would like to become a member of our repeater, please complete the following application, which will be submitted to KQ6ZZ.  Upon review and approval, we will contact you to arrange how your monthly dues will be paid.  By submitting this application, you are acknowledging you meet the requirements and agree to abide by the rules for this repeater.  For a review of the requirements and the rules, click here.

E-mail Address: *
FCC Call Sign: *
License Class: *
First Name: *
Middle Name: *
Last Name: *
Residence Street Address: *
City: *
State: *
Zip Code: *
Home Phone:
Cellular Phone: *
Alternate Email Address:
Date of Birth: *
Occupation: *
Interests/Hobbies
Comments:
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