OMIK Health & Welfare Form
The OMIK Amateur Radio Association, Inc. is always interested in the welfare of it membership both current and past.  Please use this two-part Form to leave your Name, Callsign, and your best Contact information - then, in the second part of the Form the Health & Welfare information about the person for who you are reporting about.

TNX - Steve, W0SJS, OMIK Secretary
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Your Full Name *
Your Callsign if your are a HAM
Best Contact Information for You *
Date of this submission *
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