ARES Registration Form

	AMATEUR RADIO EMERGENCY SERVICE REGISTRATION FORM

The purpose of this registration form is to provide the Emergency Coordinators in Santa Cruz County with information about amateur radio operators who are willing to volunteer their communications support during emergencies and also as a community service.

Use the TAB key to move from one field to the next.

PERSONAL INFORMATION

First Name or Handle: Last Name: Call Sign:

Address:

City: State: Zip:

Home Phone: Work Phone:

Pager: Cell Phone:

E-Mail Address: Birth Date (mm/dd/yyyy): - -

RADIO COMMUNICATION INFORMATION

License Class:

Primary radio interests, ARECC and FEMA IS courses completed and when, and comments:

Are you currently registered as a Disaster Service Worker (DSW)? Yes No
If YES, enter date your DSW ID card Expires (mm/dd/yyyy):

Check the boxes that correspond to the bands/modes you can operate.

160m 80m 40m 20m 15m 10m 6m 144Mhz 222MHz 420Mhz Other

CW

FM

RTTY

SSB

MOBILE

PACKET

If operating PACKET, the CALLSIGN of your HOME BBS is:

Can your Home Station operate without commercial power? Yes: No:

If YES, indicate bands:

If you are interested in helping with the local weekly ARES net, Check here:

If you are interested in helping with the National Traffic System (NTS) Net, Check here:

Type the "secret number" you see in this image:

...And FINALLY

Select your Emergency Coordinator (EC) to receive this registration information.
When you select an Area and then click on SUBMIT, you will get a screen
that shows you what you have entered, and you will have the chance to
Submit that, or go BACK and correct it. If you have provided an E-Mail
address, you will be sent a copy of the information you provided.
This information will only be used for ARES purposes and will
NOT be unnecessarily shared without your permission.

Santa Cruz County ARES Home Page