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2. Name

   Please enter your first and last name

3. Email Address

   Please provide your email address

4. FCC Issued Call Sign

   Please provide your FCC Issued call sign

6. Address

   Please provide your home address

8. City

   Enter your City

9. State
10. Zip Code

    Enter your Zip Code

12. Daytime Phone

    Please enter the best phone number to reach you on

13. Cell Phone

    Please provide a cell number if it is not the same as your daytime number

14. Evening Phone

    Please provide an evening phone if it is not the same as the daytime one

16. How did you find out about our RACES program?

    Please tell us how you heard about our program

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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

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