| Your Callsign: |  |  | Your Name: |  | 
	| Repeater ID1: |  |  | Repeater ID2: |  | 
	| Activation Code: |  |  | Activation Code: |  | 
	| Deactivation Code: |  |  | Deactivation Code: |  | 
	| Connection Type: |  |  | Link Method: |  | 
	
	| Multi-Link Name: | For organized links like the Intertie. | 
	| Club Web Site: | Full web site including http:// | 
	|  |