Ephrata Area Repeater Society
PO Box 674
Ephrata, PA 17522
Please hand in at a club breakfast or mail it to the address above.
Name: __________________________________
Call: ______________
Address: ____________________________ Class of license: ___________
____________________________ ARRL Member (Y/N): _____
City: __________________State: ____ Zip: _______
Phone: (_____) ____________________________
Email: ______________________________
Type Amount
___ Regular $25 __________
___ Senior (65+) $20 ___________
___ Additional Family Members $10 ___________
for each additional family member.
Donations ___________
Total enclosed: (Thank you!) ___________
Additional Family Member Names and Calls:
EARS 