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
Loma Prieta, Dan Pugh, KM6GNG
Los Altos, Jim Clark, N6JRC
Los Altos Hills, Neil Katin, K2LL
Los Gatos, Patrick Dirks, N6PWD
Milpitas, Paul Ellis, KM6IAO
Monte Sereno, Patrick Dirks, N6PWD
Morgan Hill, Gary Goelkel, K6GMG
Mountain View, Leslie Grimm, KK6EKN
NASA-Ames Mark Allard, KD6CWM
Palo Alto, Jack Pines, W1VSL
San Jose, Nigel Gore, AF6ZFM
Santa Clara, Bill Rainey, K6WAR
Saratoga, Don Steinbach, AE6PM
Stanford, Lea Roberts, WA6ITV
Sunnyvale, Wolfgang Polak, AI6SL