Loveland Repeater Association
Information/Application Form

___ I would like more information on Amateur Radio.

___ Add my name to your Amateur Radio Classes mailing list.

___ I want to join the LRA. My payment is enclosed.
___ I want to renew my LRA membership. My payment is enclosed.
         Yearly Dues start January 1st (Includes 2 free macros):
             Family Membership:        $25.00 (Pro-rated at $2.10 / Month)
             Under 18 Membership:    $5.00

Name:____________________________________

Callsign:__________________________________

Street:___________________________________

City:_____________________________________

State:____________________________________

Zip:______________________________________

Telephone:________________________________

License Class:______________________________

E-mail Address:____________________________

Packet Address:____________________________

Under 18 ?:			Yes			No
ARRL Member ?:			Yes			No

Please mail this form to:

     Loveland Repeater Association
     P.O. Box 1733
     Loveland, CO 80537-1733