ALL PURPOSE COUPON
Use TAB key to move to
new fields
Name
Nickname
Call Sign
License Class
Mailing Address
City
State
Zip
Phone Home
(include area code)
Business
PBBS
E-Mail Address
(please include)
PBPG
CHECK ONE
New
Membership
Renewal Membership
Address Change
DUES PAYMENT
CHECK ONE
$12 FOR
1 YEAR
$22 FOR 2 YEAR
$30 FOR 3 YEAR
OTHER MEMBERSHIPS
BARDS
TREASURE COAST LAN
FADCA
TAPR
DONATION: The Palm Beach Packet Group,
Inc. is an IRS-recognized 501 (c) (3) non-profit corporation.
Donations of money and equipment to the group may be deducted as provided
in Section 170 of the U.S. Internal
Revenue Code. Consult your tax specialist for more information.
If you would like to make a donation,
please specify your tax-deductible contribution:
CASH
Please provide a receipt
for my donation.
Equipment (Include Item information and
Value)
Please make
checks payable to The Palm Beach Packet Group and mail to:
Palm Beach Packet Group
1043 Widgeon
Rd Wellington, Fl 33414
Please do not write below this line
Received _______________ Cash ________________ Check #
_______________ by _____________________
Entered ___________________ Expiration
_____________ by _____________________
(Please print a copy of the confirmation page for your
records after submitting form)
