Please Print
Name:__________________________________________________________________________________
Call Sign (if any):__________________________________________________________________________
Address:_________________________________________________________________________________
City:____________________________________________________________________________________
State:___________________________________________________________________________________
Zip:_____________________________________________________________________________________
E-mail address:____________________________________________________________________________
Please check one
Send me my BSSS by e-mail ___
Send me my BSSS by mail ___
Send me my BSSS by both ___
Send to:
Kenneth A. Ebneter
822 Wauona Trail
Portage WI 53901
