March of Dimes WalkAmerica Sign-up Form

Public Service Communications Event

Enter your name and call:
Enter your email address :
Home phone (optional) :
Work phone (optional) :
Enter your T-Shirt size :

What Resource Type are you ?
(Enter all that apply)

Type S Type B Type M Type DT Type DA Type DM Type H
(See Communicator Resource Type Guide.)

Enter comments, operating preferences, and/or equipment :


Thanks for supporting Public Service Events.


Note: This form may not work from web based email programs.

Send comments or suggestions to:
John Galvin, n5tim@arrl.net

Copyright © 1998-2008 John Galvin Last Modified 02-01-08