LARC Class Registration Form
Information to be used for class purposes only. Your information is NOT shared with anyone else by us for ANY reason. It is only used by Kat (W0UM) & Bryan (AF0W) Gonderinger (Instructors), for LARC Educational purposes.

NOTE: You are not fully registered with a reserved seat until you have paid for this class. There are only 14 seats available.

To guarantee your seat for the class, please send a check or money order for the registration amount for the class, and if you want to purchase the spiral-bound General Class License book from us with our instructor discount, please add $25. You can mail it to Kat Gonderinger, W0UM, at 2313 Bobwhite Lane, Longmont, CO, 80504. Please make your check out to LARC, or Longmont Amateur Radio Club.

The class fees are: Technician Class ($25), General Class ($30), and Extra Class ($50). If the class is full, you will be put on a waiting list and informed

Seats are not guaranteed until paid -- but you are also welcome to attend the first class on Monday, 10/08, at 6:00 pm and pay cash if you wish, if we still have room in the class. Either way, please register and let me know your intentions.

You can contact Kat & Bryan, the Instructors, at w0um.kat at gmail.com if you have any questions.

Email address *
First Name *
Your answer
Last Name *
Your answer
Callsign or FRN (Leave blank if you don't have one yet):
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Primary Phone: *
Your answer
Other Phone:
Your answer
For Which Class Are You Registering? *
Required Class Textbook: *
Where, or from who, did you Hear About this Class? *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service