ALLIANCE MEMBERSHIP OPTION FORM

First name

Last name

GMRS call-sign

Option 1: I understand that I will be receiving a pro-rated refund of my membership fees based on the amount of unused time on my membership. I am requesting that all of my contact information be deleted from the club's database including the website, telegram, ZELLO and any other platforms maintained by the former NYS GMRS Alliance.

Option 2: I understand that I will be receiving a pro-rated refund of my membership fees based on the amount of unused time on my membership. I am requesting that the club retain my contact information including name, call-sign and email address to keep me informed of any possible updates within our GMRS community.

To process your pro-rated membership fee refund, you must provide the following:

Name to be printed on the pro-rated membership fee refund check:

Street address/PO Box

City/Town

State

Zip Code