Burke County ARES Registration Form

Burke County ARES Registration Form

AMATEUR RADIO EMERGENCY SERVICE

REGISTRATION FORM

Please make sure your contact information is correct. I will be using this information to get in contact with you and if this information is not correct I can not contact you. Thank You

FirstName:

LastName:

Call:

Address:

City

State: Zip:

County:

Bus. phone:

Home phone:

Cell phone or Pager

License Class:

Primary Radio Interest:

Check bands/modes you can operate:

If Operating Packet, The call sign of your PBBS is:

Can your home station operate without commercial power?

YES NO

If Yes what bands:

Your E-Mail Address:

Closest FireStation:

Closest School:

This will be sent to Greg Branch, the Burke County Emergency Coordinator, he will review the information and mail you a form to sign stating you wish to become a ARES member.

You must be a licensed Amateur Radio Operator!

ki4gzd@hotmail.com

Page last updated on October 17, 2005