First Name:              Last Name:        Call Sign: 

Address:          

City:       State:          Zip:  

Home Phone + area code:       Work Phone + area code:  

License Class:  

Primary Radio Interest:

Mark each box for the bands and modes that you can operate:

Can your home station operate without commercial power?   Yes No

If yes, what bands can you operate: 

Do you have E-mail?  Yes No

E-mail address: 

This is a serve at will position. Either you or the local ARES can terminate at any time, with or without reason.

You will be contacted to have your photo taken for your ARES I.D. Card. The Coffee County ARES Standard Operating Procedures will be sent to the above address along with other information.

If you have completed all of the above questions please enter your name below. 

It will be considered as your handwritten signature.

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"ATTENTION AOL USERS, and those not wanting to electronically send personal information over the Internet."

If you do not wish to send personal information over the Internet, or you are using AOL as your Internet Provider, please use your browser's print button and print 2 copies of the completed form. You are to keep one copy for your records and mail the second copy to the address below. Once received, you will be contacted for arrangements for a picture and I.D. Card.

670 Mossy Oak Rd

Douglas, Ga 31535

Attention: E.C.

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