Cheyenne Mountain Repeater Group Inc.
P.O. Box 50331
Colorado Springs, CO 80949

Phone number:

E-Mail address:


Call Sign:______________

    Name:

 Address:
    City:
   State:
Zip Code:

(Please circle one)
Are you a Member of ARRL?:  YES    NO


PRICE IS [$25.00 or $40.00] and THIS INCLUDES YOUR SPOUSE, A DAUGHTER, 
AND/OR A SON IF THEY HAVE A CALL SIGN:

    Family members' Name & Call sign:_____________________________

                                    :_____________________________

                                    :_____________________________