Name___________________________________

Call Sign ________________________

Spouse Name_________________________________

Spouse Call Sign ____________________

Street Address______________________________________________________

City_____________________________________

State _____________________

Zip+4 ______________________

License Class___________________________

Spouse License Class ______________________

HRRVC National Number _____________________

Telephone _______________________________

E-mail _______________________________

Spouse E-mail __________________________________
 

Annual Fee $5.00 (per family) payable in July
Make check payable to Holiday Hams Chapter #435

Send to: Bob Metcalf
               10201 Stanley Rd.
               Flushing, MI 46433