ARES Registration Form

AMATEUR RADIO EMERGENCY SERVICE
ARES Registration Form
Napa, CA

Instructions: Fill in the form as best you can. Do not press enter until you are ready to send the form. Use Tab or your mouse to move between input boxes. All information collected on this screen will be used for ARRL East Bay Section ARES purposes only.

Name:
Call sign:
Mailing Address:
City, State ZIP:
Email Address:
Home Phone:
Work Phone:
Cell Phone:
License Class:

Check bands and modes that you can operate:

MODE

6
Meters

2 Meters

220
MHz

440
MHz

Other

SSB
CW
FM
DATA
Packet
Other Bands and Modes indicate below:

Can your home station be operated without commercial power? Yes No

Comments:

Napa County District Emergency Coordinator
KE6O ke6o@comcast.net