AMATEUR RADIO EMERGENCY SERVICE
REGISTRATION FORM
The purpose of this registration form is to provide the Emergency Coordinators in Santa Clara County with information about Amateur Radio Operators who are willing to volunteer their commuications support during emergencies and also as a community service.   ARES is the field arm of the Amateur Radio Relay League (ARRL).

What is ARES?   What is RACES?   Why ARES/RACES?   What is ACS?
Use the TAB key to move from one field to the next.
Form Instructions

PERSONAL INFORMATION

First Name:       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 Interest:

Are you currently registered as a Disaster Service Worker (DSW)?     Yes     No
      If YES, enter Expiration Date (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 CALL SIGN of your PBBS 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 Net, Check here:
If you are interested in helping with the National Traffic System (NTS) Net, Check here:

...And FINALLY

Select the City/Emergency Coordinator (EC) to receive this registration.
When you select an EC 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/RACES activities and will
NOT be shared with outsiders without your permission.

     

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