APPLICATION FOR RELAY STATION STATUS

Mail to:
   PO BOX 135
   ESTER AK 99725
   USA

Note: SCC = Starfleet Clearance Code. It is the membership number you are given upon
joining Starfleet International. 

Tentative Relay Station Number: RS-10___ (assigned by RC)

   Name of future CO: ____________________________
                 SCC: ____________________________
     Mailing Address: ____________________________
                City: ____________________________
      State/Province: ____________________________
     Zip/Postal Code: ____________________________

      E-mail Address: ____________________________
        Phone Number: ____________________________

Name of other member: ____________________________
                 SCC: ____________________________
     Mailing Address: ____________________________
                City: ____________________________
      State/Province: ____________________________
     Zip/Postal Code: ____________________________

Additional members and addresses may be listed on the back. 

Please state your short term and long term goals: that is, what you hope your group
will accomplish and what you see as its purpose now and in the future. The main
reason for this is to enable us at Region 10 Headquarters to help you and your Relay
Station in the future.