Name: ___________________________________ Call: ___________
Address: ___________________________________________________
______________________________________ Zip: _______
Home Phone: ________________ Work Phone: _______________
Note: If you have an unlisted number, you may omit your phone number. However, if you wish an Autopatch number, you must give your number to the party who programs Autopatch numbers. Your home phone number will not be listed; however, your Autopatch number will be listed.
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What are your station's capabilities:
VHF ___ UHF ___ ATV ___ PACKET ___ SATELLITE ___ HF ___ BASE ___ MOBILE ___
-...-
Where do your interests lie:
Building ___ Public Service ___ Rag Chewing ___ Contesting ___
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What do you want from meetings:
Business only ___ Social ___ Programs ___ Demos ___
Other ________________________________________________
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By accepting membership in the Laurel Highlands VHF Society, Inc., I agree to abide by the Society's by-laws and to participate to the extent that I am capable in Society functions.
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Signature/date