Arizona Amateurs On Television

Name_________________________ Call sign______________________________

Address_______________________ E-Mail________________________________

Home Phone____________________Cell Phone___________________________

Regular Membership $25.00 per year, January thru December

Family Membership $40.00 per year, January thru December

Family Members___________________ Relationship_______________________

Please fill out form and mail to:

BRUCE R PAULSEN, N7TV

18060 N 24TH DR

PHOENIX, AZ 85023-1219

USA