ARRL

Request for Graduation Kit Materials

Use this form to request Graduation Kit materials including the following:

First Name *

Last Name *

Call Sign *

Telephone Number *

E-mail Address *

Club Name

Date of class completion *

Please indicate when you will need these materials

Quantity needed *

Standard kit (20 copies of each item)Custom kit

Indicate whether you would like the standard kit or want to order a specific quantity of materials (more than 20 copies of each item).

Please tell us where to ship these materials.

Address line 1 *

Address line 2

City *

State *

Zip code *

Additional requests or comments:

Please include any specific requests for these materials not covered in the information supplied above.