K9WZ REPEATER
MEMBERSHIP APPLICATION FORM  
     rev 11/15/2002


PRIMARY MEMBERSHIP:  $ 25.00 PER YEAR

 Entitles you to all the privileges of membership- including an autodial slot and inclusion on the mailing list.
 All paperwork is sent to you regarding membership status. At least the first person to join from a family must
 join at this level.

ASSOCIATE FAMILY MEMBER: $ 10.00 PER YEAR

  Available only to the family members of a Primary Member, living at the same address. Membership allows family
members to use the repeater. Since no additional  user number, DVR slot, or autodial number will be issued to the
Associate Family Members, they will have to use those items issued to their Primary Member.



Primary Member ( Must have at least one Primary Member to Join the Repeater Group)

Name: _________________________________________________ Call Sign: ______________

Street: ________________________________________________________________________

City: ______________________________________ State:__________  Zip:________________

Home Phone: ________________________________________

Number  you want in autodial slot if not same as above: ___________________________________

Email Address __________________________________________________________________


Associate Family Members: (Living at the same address as Primary member ) $10.00 per person

Name and Call : ________________________________________________________________

                _________________________________________________________________
                
                _________________________________________________________________

                _________________________________________________________________
  
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Checks should be made out to WAYNE ZEHNER JR.

Send the completed form and check to this address:

K9WZ Repeater
11317 Iris Court
Plymouth, In. 46563-7667