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ARES/RACES Registration |
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"Amateur Radio Volunteers for Community Emergency Communications Service" |
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Registration |
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Date:____/____/____ Call Sign:______________ Class:________________ |
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Last Name:____________________ First:____________________ Middle Initial:________ |
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Address:________________________________________________ City:______________________ |
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State:__________ Zip:___________ County:_________________ ARRL Member?_________ |
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Phones: Residence:___________________ Pager:_________________ Mobile:________________ |
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Fax:___________________ Work:___________________ Other:_______________________ |
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Email:_____________________________________________________________________________ |
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Employment: [ ] Full Time [ ] Part Time [ ] Retired Normal Working Hours:_______________ |
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Specific Availability Times:__________________________________________________________ |
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Nearest Hospital:_________________________________ ETA in minutes:___________________ |
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Base Station Capability (HF, 2M, etc.):________________________________________________ |
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Mobile Capability (HF, 2M, etc.):______________________________________________________ |
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Auxiliary Power: [ ] Battery [ ] Generator Is your auxiliary power portable? [ ] Yes [ ] No |
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Are you currently a volunteer in any other emergency organization? [ ] Yes [ ] No |
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Organization Name:_____________________________ Location:_______________________ |
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Other Strike Team Members:_______________________________________________________ |
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Additional Personal and/or Technical Information: |
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Signature:_______________________________________ Date:_________________ |
