Please PRINT and fill out this form and mail to the address below, along with your check to:

Marv Anderson KA0EOE
AARC
117 W Main
Ceresco, NE 68017

Make all checks payable to Ashland A.R.C.

Name:_______________________________________

Callsign:______________________________________

Street Address:________________________________

City:________________________________________

State:________________     Zipcode:______________

(Place an X on the type of membership desired)
New Membership:____    or  Renewal Membership: ____

(Enter number of members joining)
Primary Member:__1___  @ 20.00 ea. per year

Family Members:______  @  5.00 ea. per year

                                           $_______  total