Public Service Event Sign-up Form

Your full name:
Your email address, if you have one: (e.g.: you@aol.com)

Your phone number (with country, city, area codes):

Address:
City: State: Zip:

Callsign


What Public Service Event Are You Signing Up For? (Note: If You Are Just Wanting Your Name On File For Any Future Event, Simply Put "Add Me To Your Contact List")


What Type Of Ham Radio Gear Do You Have? (It is preferred that your gear have tone capability but is not required). Please Check All That Apply.   HT (Handie-Talkie   Dual-Band?   Mobile Rig?
List Any Other Gear That Could Be Used In The Field, i.e. HF-rig, generator, extra antennas (beams, dipoles and such), etc.





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