Coshocton County Amateur Radio Emergency Service - ARES Registration Form Name___________________________________________ Call______________________ Address____________________________________________________________________ City/State/ZIP_____________________________________________________________ County______________________ License Class________ Email Adr______________ Home Ph.________________ Bus, Ph._________________ Cell Ph._______________ Pager__________________ Circle All That Apply Home Station CW 80 40 20 15 10 6 2 220 440 Courses Taken: SSB 80 40 20 15 10 6 2 220 440 ARRL EMCOMM FM 80 40 20 15 10 6 2 220 440 Level I RTTY 80 40 20 15 10 6 2 220 440 Level II PACKET 80 40 20 15 10 6 2 220 440 Level III PSK31 80 40 20 15 10 6 2 220 440 Basic (New) FAX 80 40 20 15 10 6 2 220 440 Advanced (New) _______ 80 40 20 15 10 6 2 220 440 _______ 80 40 20 15 10 6 2 220 440 FEMA Battery 80 40 20 15 10 6 2 220 440 IS-100 Generator 80 40 20 15 10 6 2 220 440 IS-200 IS-700 Portable Station IS-900 CW 80 40 20 15 10 6 2 220 440 SSB 80 40 20 15 10 6 2 220 440 Other (List) FM 80 40 20 15 10 6 2 220 440 _____________________ RTTY 80 40 20 15 10 6 2 220 440 _____________________ PACKET 80 40 20 15 10 6 2 220 440 _____________________ PSK31 80 40 20 15 10 6 2 220 440 _____________________ FAX 80 40 20 15 10 6 2 220 440 _____________________ ______ 80 40 20 15 10 6 2 220 440 ______ 80 40 20 15 10 6 2 220 440 Battery 80 40 20 15 10 6 2 220 440 Generator 80 40 20 15 10 6 2 220 440 Mobile Station CW 80 40 20 15 10 6 2 220 440 SSB 80 40 20 15 10 6 2 220 440 FM 80 40 20 15 10 6 2 220 440 RTTY 80 40 20 15 10 6 2 220 440 PACKET 80 40 20 15 10 6 2 220 440 PSK31 80 40 20 15 10 6 2 220 440 FAX 80 40 20 15 10 6 2 220 440 ______ 80 40 20 15 10 6 2 220 440 ______ 80 40 20 15 10 6 2 220 440 Signed________________________________________ Date___________ Mail To: CCARA P.O.Box 501 Coshocton,OH 43812