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, for LARC Educational purposes.

NOTE: You are not fully registered with a reserved seat until you have paid for the class. Payment information will be provided once your registration has been confirmed. You can contact Kat at w0um.kat at gmail.com.

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 did you Hear About this Class? *
Your answer
A copy of your responses will be emailed to the address you provided.
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