Columbiana County Ohio A.R.E.S.

REGISTRATION FORM

  Name:    Call:    SKYWARN No.:

AMATEUR RADIO EMERGENCY SERVICE

  Address:   City:   State:   Zip:
Buisness Phone:     Home Phone: Unlisted        County:
  License Class:        Primary radio interest:
Check bands/modes you can operate:

   160M     80m    40m      20m    15m     10m      6m      2m      1.4m     70cm     Other
            CW                                                                              
            FM                                                                              
        RTTY                                                                              
           SSB                                                                              
  MOBILE                                                                              
  PACKET                                                                              
   TALKIE                                                                              
             IF OPERATING PACKET, THE CALLSIGN OF YOUR PBBS IS:
             Can your home station operate without commercial power ?
          ON WHAT BANDS CAN YOU OPERATE EMEGENCY POWER ?
      
         Your e-mail address

            
       Print this form out and mail it to the address below: __________________________________________________________________
Columbiana County ARRL E.C.
c/o Mel Lippiatt
P.O. Box 209
Salem, Ohio 44460-0209
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