ELMER J. FUDD NET CHAPTER OF 10-10 INTERNATIONAL

Name________________________ Call____________ 10-10#____________
Home Address____________________________________________________
E-mail Address_____________________________ Birthday M/D________
Name desired on certificate_____________________________________

Permission to post your email address 
on the Elmer Fudd Web page:  Yes__  No__

SQ/IQ by ____________    Elmer J. Fudd Net # _____

or

    Call sign        Name           Fudd #
1.  ____________     _____________  _____
2.  ____________     _____________  _____
3.  ____________     _____________  _____
4.  ____________     _____________  _____
5.  ____________     _____________  _____
6.  ____________     _____________  _____
7.  ____________     _____________  _____
8.  ____________     _____________  _____
9.  ____________     _____________  _____
10. ____________     _____________  _____



Send $2.00 ($3.00 for DX) with proof of up to date 10-10 dues to:
Robert Fulton Jr.  N3NOP
1342 7th Ave.
Berwick, PA. 18603