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Date:
Name:
Last, First, Middle
Address:
City/Province:
Nationality:
Do you have a Club Affiliation?:
yes/no
If yes:
Telephone#:
Cell Phone#:
Email:

That I, (
type name here), am voluntary joining the NORTHERN AMATEUR RADIO
ASSOCIATION, INC. and hereby obey and comply with its existing rule, regulation,
and by-laws. Any violations here of shall be ground for my SUSPENSION,
EXPULSION, and/or TERMINATION.



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