ARES Membership Application

This form is used to record membership data for Licking County, OH ARES volunteers.

Please provide the following contact information:

Name  
Call/Class
Street Address
Address (cont.)
City
State
Zip Code
Work Phone
Home Phone
E-mail
URL

Check the bands/modes you can operate:

    HF                    CW  FM DATA SSB MOBILE PACKET

    6 METERS        CW  FM DATA SSB MOBILE PACKET

    2 METERS        CW  FM DATA SSB MOBILE PACKET

    70 CM               CW  FM DATA SSB MOBILE PACKET

Can your home station be operated without commercial power?  Yes  No  

    If yes, which bands?  HF 6M 2M 70cm

Are you currently registered with any other ARES program, and if so, which county?

    No  Yes  County: 

 

Copyright © 2005-2007 [LickingCountyARES]. All rights reserved.
Revised: December 08, 2007