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OMISS Lifetime Membership Fee

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OMISS Membership Application

Please fill out the following information and click the submit button.
"*" indicates mandatory fields.
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*Callsign
*First Name
*Last Name
Nickname
*Email
*Verify Email
*Address
Address2
*City
*State/Province
 
*Postal Code
*My station is located within the corporate limits of a State Capital
True False
*County
*GRID
*Country
Other:  
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OMISS Contact information
(Two Contacts made with OMISS Members during any OMISS Net are Required for Membership)

*OMISS #
*Call
*Date:
*Time UTC:
:
*Frequency
*OMISS #
*Call
*Date:
*Time UTC:
:
*Frequency

First Responder Information (optional)
This is to be eligible to be worked for our First Responder Awards.
(Check all that apply)

Dispatcher
EMT/Paramedic
Firefighter
Police

Military Service Information (optional)
This is to be eligible to be worked for our E'Sprit de Military Awards.
(Check all that apply)

US Army
US Navy
US Air Force
US Marine Corps
US Coast Guard
Reserves
National Guard Unit