AMATEUR RADIO EMERGENCY SERVICE
REGISTRATION FORM
Last Name - First Name - Amateur Call
Street Address City State Zip
Home Phone Work Phone Cell Phone
Email Email2 Age -

ARRL Member - NOTE: You do not have to be an ARRL member to join ARES

License Class:
Technician
Tech Plus
General
Advanced
Extra

Equipment Capabilities:
HF - SSB CW FM Data Packet / PSK-31 Mobile
6 Meters - SSB CW FM Data Packet / PSK-31 Mobile
2 Meters - SSB CW FM Data Packet / PSK-31 Mobile
222 Mhz - SSB CW FM Data Packet / PSK-31 Mobile
440 Mhz - SSB CW FM Data Packet / PSK-31 Mobile
 

Disaster or Communications related training you have had:
Storm Spotter
CERT
FEMA or other EMA Training
RACES
Red Cross
MARS
Salvation Army, Southern Baptist, or other Faith Based Disaster Training - List Below
ARRL or other Emergency Communications courses - List Below

Do you have APRS capabilities? Yes No

Do you have a GPS? Yes No
Can your home station be operated without commercial power? Yes No
Do you have any disabilities that would prevent you from serving in the field? Yes No
If "Yes", can you serve as a base operator from your home? Yes No
If "Yes", do you have internet/email capability in your shack? Yes No


Comments

 

If you do not receive a confirmation email within 24 hours please re-submit your application.


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