Complete the form below to be added to the 415 Member Roster. Your name, callsign, city, and state will be listed on our website member roster page. Submitting this form indicates that you consent to having your name, callsign, city, and state listed. The 415 will not distribute your information to ANY 3rd party. Submissions may be checked through an automated spam detection service. See our Privacy Policy for more information.

First Name *

Last Name *

Callsign0 / 6

Street Address

Apartment, suite, etc

City *

State *0 / 2

Zip Code0 / 5

Email Address *

Phone Number *

415 Roster Listing ConsentI consent to be listed on the 415 Member Roster

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