MAREX MG® 

Manned Amateur Radio Experiment MG Corp.
3 Moccasin Lane
Chelmsford Massachusetts 01824 USA
marexmg@comcast.net

Donation Form

To: MAREX MG

Please accept this donation to MAREX MG for supporting existing and future Educational Amateur Radio Space projects. I understand that I may make the donation by check.

Name: _________________________________________ Call Sign:____________

Address: ____________________________________________________________

City: __________________________ State / Province: ________

ZIP/Post code: _______________ e-mail address: ________________________

Please make check payable to MAREX MG

Check Amount: ______________________________ Number: ____________

Daytime Telephone Number _____________________________ (optional)

Signature: ________________________________________ Date: ___________

2003.07.11