First Name:
Middle Initial, Last Name:
Nickname/Flying Name:
Address (Street or P.O.Box):
City: CA ZIP:
EMAIL:
Home Phone: Work Phone:
Cell Phone: HAM Call Sign:
USHGA Number: USHGA Expiration (MM/DD/YY):
Rating(s): Birthday (Optional):
Emergency Contact: Emergency Phone #:

   Check here if you do not want personal information  listed in the ROSTER

Annual Renewal @ $20 $ Mail To: Humboldt Wings Treasurer
New Members @ $2/Month (Max $20) $ Bruce Champie
Donation  $ 4405 Alderpoint Road
Total Amount Due $ Garberville  CA  95542

Last Modified: 7 January 2005