LARC Directory Opt-in
This is for LARC members only.

Please select the information you are willing to have included in the directory. The only required fields are your name and call sign so that your information can be matched to the membership records. The default option is to not include.

All permitted information will be pulled from the membership database unless you supply other information below. Any updated information supplied below will be added to the membership database.

Name *
Your answer
Call Sign *
Your answer
Class *
Include my name and call sign *
If this is not selected, nothing will be included, so you must select 'Yes' before submitting the form.
Include my address
Mailing address you want included if different from where your LOG is delivered.
Your answer
Include my phone number
Phone number
Please enter to ensure we publish the correct number. Format ###-###-####
Your answer
Include my email address
Email address
Please enter to ensure we publish the correct email address.
Your answer
Your answer
Never submit passwords through Google Forms.
This form was created inside of