ARRL

HPM Nomination Form

Nomination form for the 2009 Hiram Percy Maxim Award

Name *

Person you are nominating

Call Sign *

Address *

City *

State

ZIP *

Day Phone *

E-mail *

Comments *

Please provide a short summary of this nominee's accomplishmnets

Your Name *

Yourself

Your Call Sign *

Your Address *

Your City

Your State *

Your ZIP *

Your Day phone *

Your E-mail *

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HPM Nomination Form