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

Pam Hitz-NØPJB
AARC
2455 Co. Road H
Weston NE. 68070

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