ARES Application
(Page Rev: 11/16/03)
(
*
Required Field)
Name First/Last:
*
Call Sign :
*
License Class
Select Class
Extra
General
Advanced
Technician+
Technician
*
E-Mail:
P.O. Box:
Street Address:
*
City/St/Zip:
,
*
County:
*
Home Phone:
*
Business Phone:
PBBS Packet Call Sign:
SKYWARN #:
Completed Red Cross -
Intro Disaster Service Class:
Date
Have Portable
Emergency Generator :
Watts
Primary Radio Interest:
Participation Level:
ACTIVE STATUS
- I am committed to regular participation in meetings, training, drills, and other on-going activities and who constitute the core group of “prepared” ready-to-respond personnel.
RESERVE STATUS
- I am are willing to provide communications support in the event of a disaster or other emergency situation, but who prefer not to participate in meetings, training, drills and other activities on a regular basis.
HOME STATUS
- I would prefer working from home.
MODE
>
CW
FM
SSB
Mobile
Packet
Indicate the Bands/Modes
you can operate. Hold down
the "CTRL" key and click on
the Band/s
At least one selection MUST be made in each column for the form to process correctly
None
160
80
60
40
20
15
10
6
2
220
440
None
160
80
60
40
20
15
10
6
2
220
440
None
160
80
60
40
20
15
10
6
2
220
None
160
80
60
40
20
15
10
6
2
220
440
None
6
2
220
I __________________________, ______________ hereby apply to be registered with the Amateur Radio Emergency Service. To the best of my ability, I agree to abide by all FCC Rules and Regulations and practice good radio operating procedures as defined by the American Radio Relay League. I also agree to abide by "The Amateur's Code" and participate in ARES training, drills and exercises, as well as actual emergency incidents, as long as my family and work schedules allow. I also affirm that I have never been convicted of a felony and that I have no outstanding warrants for my arrest and that I am not a fugitive from justice. Signed ___________________________ date ___________ witness _______________ Amateur license verified by _________________________ exp. ________________ Identified by: CDL No (or other): ____________________ by __________________
A confirmation E-Mail will be sent to the above E-Mail address.