Name: ______________________________________________________ Call Sign:________________________
Address:_____________________________________________________________________________________
City:___________________________________ State:__________________________ Zip Code:_______________
Website: http://___________________________________________ Email:________________________________
Home Phone (____) _______________ Work Phone (____) _______________ Cell Phone (____) _______________
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Circle Bands you can work. 160m 80/75m 40m 30m 20m 17m 15m 12m 10m 6m 2m 1.25m 70c/440 902mhz&higher
What digital modes are you capable of operating?______________________________________________________
Can you operate CW
?_____________ Do you have facilities at home QTH for CW ?_________________________
Do you have emergency power. if yes what type?
(batteries or generator)_________________________________________
What license class are you?_________________________ Do you have Skywarn training?_____________________
Are you a member of ARRL?______ Are you a member of RACES/ARES?______ MARS call if any?___________
Do you have HT's, if yes what band(s)?______________________________________________________________
Do you have Mobiles, if yes what band(s)?___________________________________________________________
Number of computer(s) (zero for none)_____Desktop _____Laptop. Internet access type if any? Dialup or DSL/Cable
Do you have a Weather Station?_____________ Do you have a NOAA Weather Radio?________________________
Can you operate at the 911 center during an emergency? If yes give preferred hours:________________________
Are you interested in teaching an Amateur Radio class?(elmer)________________________________
Could you help as a VE (volunteer examiner)? If yes what months?___________________________________________
Are you interested in a local Net?________ Would you be willing as Net Control operator?______________________
Would you be interested in doing a demonstration or program at a Club meeting?_____________________________
"I have received a copy of the EARS by-laws and agree to abide by the rules and statutes therein and that shall from time to time be amended, approved and published by the EARS membership. I further stipulate by signing below that I have never been convicted of a felony involving moral turpitude under federal law or laws of the several states."
Signature:_________________________________
