Coshocton County Amateur Radio Emergency Service® - ARES®

Registration Form 2015

Name_ __________________________ Call_____________ Exp. Date___________

Address__ ________________________________________________

City/State/ZIP_______________________________________________________________

County____________ License Class___________ Email__________________________ 

Home Ph___________________  Cell Ph______________________________

Underline All That Apply:						   
Home Station 
CW        	HF	6	2  	440	Courses Taken:
SSB       	HF	6	2  	440		ARRL EMCOMM 
FM         	HF	6	2  	440              EC-001  ____
                                   		Level I   ____
RTTY	HF	6	2  	440		Level II  ____
PACKET	HF	6	2  	440		Level III ____
PSK31	HF	6	2  	440		FEMA
FAX	HF	6	2  	440		IS-100 ____
___________	HF	6	2  	440		IS-200 ____
___________	HF	6	2  	440		IS-700 ____
Battery	_____					IS-800 ____
Generator	_____					Other (List)
						
Portable Station:					
CW        	HF	6	2  	440		
SSB       	HF	6	2  	440		
FM         	HF	6	2  	440				
RTTY	HF	6	2  	440				
PACKET	HF	6	2  	440		
PSK31	HF	6	2  	440		
FAX	HF	6	2  	440	Current ARES Badge	____		
___________	HF	6	2  	440	Current SkyWarn ID	____		
___________	HF	6	2  	440	Red Cross background check	____		
Battery____ Generator_____			ARRL Member(in ARES not req)	____					
Mobile Station
CW        	HF	6	2  	440		
SSB       	HF	6	2  	440		
FM         	HF	6	2  	440		
RTTY	HF	6	2  	440				
PACKET	HF	6	2  	440		
PSK31	HF	6	2  	440		
FAX	HF	6	2  	440		
___________	HF	6	2  	440		
Battery_____ Generator_____	

Are you FLDIGI capable _______
Please indicate if you would be willing to serve as an ARES Volunteer in surrounding counties if requested by the District Emergency Coordinator.    yes   No 

Signed_________________________________________   Date___________________
Email to: AA8BN@ARRL.NET   (or)
Mail To: CCARA  P.O.BOX 501   Coshocton, OH 43812