TAB key to move from one field to the next. Form Instructions
PERSONAL INFORMATION First Name:
Birth Date (mm-dd-yyyy):
RADIO COMMUNICATION INFORMATION License Class:
Primary Radio Interest:
Disaster Service Worker (DSW) coverage? :
DSW Paperwork on file with:
Santa Clara County
Check the boxes that correspond to the bands/modes you can operate.
If operating PACKET, the CALL SIGN of your PBBS is:
Can your Home Station Operate without commercial power?
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.
Campbell, Barton Smith, N6HDN
Cupertino, Jim Oberhofer, KN6PE
Gilroy, Pat Moore, K6PMM
Los Altos, Tom Smith, KD6SOJ
Los Altos Hills, Ed Jones, W7WPO
Los Gatos, Bert Fry, K6BRF, EC
Milpitas, Tim Howard, KE6TIM
Monte Sereno, Bert Fry, K6BRF, EC
Morgan Hill, Woody Salyer, K6WWS
Mountain View, Jerry Haag, K6GAC
NASA-Amesm Mark Allard, KD6CWM
Palo Alto, Paul Lufkin, K6PML
San Jose, Chris Swartout, N6WCP
Santa Clara, Bill Rainey, K6WAR
Saratoga, Don Steinbach, AE6PM
Stanford, Lea Roberts, WA6ITV
Sunnyvale, Jerry Thalls, KG6HI