ARES APPLICATION

Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
County
Work Phone
Home Phone
Cell Phone
E-mail
URL

Enter your CALLSIGN in the space provided below.

Choose your CLASS of license from one of the following options:

NOVICE
TECH
GENERAL
ADVANCED
EXTRA

Do you own an HT ?

Yes No

Select what BANDS your HT covers from any of the following options that apply:

2 METERS    220         440         1.2Ghz.   
DUAL BAND   TRI-BAND    

Do you own a Mobile rig?

Yes No

Select what BANDS your MOBILE rig covers from any of the following options that apply:

2 METERS   220        440        1.2Ghz.  
DUAL BAND  TRI-BAND   HF         

Can you operate the HF Bands?

Yes No

Select what HF Bands you can operate from any of the following options that apply:

160 METERS  80 METERS   75 METERS   60 METERS 
40 METERS   20 METERS   17 METERS   15 METERS 
12 METERS   10 METERS   6 METERS    

What are you Ham Radio Interests? (Please enter your interests or N/A in the below box.  Do not SKIP or leave blank as data IS required!)

Do you own a 4 Wheel Drive Vehicle?

Yes No

Do you have any health problems or disabilities which might restrict your ARES activity? (If yes, please explain! If No, please state "NO" Do not SKIP or leave blank as data IS required!)

Are you available to assist on a Communications Assistance Team (CAT) in disasters areas elsewhere, for periods up to one week at a time?

Yes No

Please enter any comments related to "CAT" activities here. (Please enter your CAT comments in the below box or enter "N/A" if you have no comments.  Do not SKIP or leave blank!)