Print and send application and check to:

RIVER RAISIN REPEATER ASSOCIATION. INC.
567 West Vienna Rd., Temperance, MI  48182

Name ______________________________  Call ________________ ARRL Member? ___

Address ________________________________________  Phone _____________________

City  _____________________________________  State ______  ZIP _________________

E-Mail Address _____________________________________________________________

Speed Dial Slot #1 (@ $5.00)  ________  Desired Phone # ___________________________

Speed Dial Slot #2 (@ $5.00)  ________  Desired Phone # ___________________________

Membership: (@ $15.00) _________  Family Members (@ $5.00ea) ___________________

Total Enclosed:  ______________________________________________________________