Lincoln County NM Radio Amateur Civil Emergency Radio Service (RACES)                                        Page 1/2

Application Form

               I hereby apply for membership in the Lincoln County, NM RACES program.  

               I understand and will comply with the following:

1. RACES is operated under the Amateur Radio Service Part 97 subpart 97.407, RACES is a formal governmental controlled service, an can only operate during a declared emergency / disaster event.  The RACES program is managed and controlled by the State, or City/County government.  Very strict rules apply to RACES operation.  The State or City/County government officials will require background checks and other requirements prior to certifying a RACES member.  Because of this RACES members can be considered as volunteer unpaid employees who can perform communications duties of a sensitive nature.

1. Minimum  requirements for membership in RACES:

1. Must possess a current amateur radio license issued by the U.S.  Federal  communications Commission.

2. Must be aware he/she may be the subject of a background check by an appropriate official/agency of the State or local government to determine that he/she is free of  any felony convictions.

3. Must be a U.S. citizen.

1. Causes for dismissal/revocation of membership:

1. Fraud in securing appointment.

2. Dishonesty.

3. Drunk  or under the influence of an illegal/controlled substance while on duty.

4. Conviction of a felony or conviction of a misdemeanor involving moral turpitude.

5. Misuse of government property, including an identification card.

6. Discourteous treatment of supervisors, employees, the public or other volunteers.  

7. Willful disobedience of a supervisor.

8. Unlawful discrimination, including harassment, on the basis of race, religion, color, national origin, physical handicap, sex or age, against the public, employees or  volunteers while acting in the capacity of a RACES member.

9. Consistent failure to perform as required.

_______________________________________________________________________________________________________________________________________

Lincoln County NM Radio Amateur Civil Emergency Radio Service (RACES)                                                                Page 2/2

Application Form

1. My membership appointment is at the pleasure and control of the Director of Emergency Management/Civil Defense, of Lincoln County NM.

2. RACES Identification cards are the property of the state or local government jurisdiction.  

3. The use of my personal radio equipment is at my own risk, and will be under my control at all times.  

4. I will follow current FCC and Lincoln County rules and procedures regarding use of my own or any county owned radio equipment, under my control.  

5. I agree to follow the direction, supervision of the officials of the State of New Mexico and Lincoln County, New Mexico.  

6. I understand that the information contained herein will be kept confidential but will be used to process a background check required prior to my membership being approved in Lincoln County RACES program.  

Name:                                                        Amateur Call Sign:                        

        ________________________________                                ___________________

Address:                                                                                        

_____________________________________

City:                                                        State:                   Zip:                

_______________________________                _________                _______________ -   _____________

SS#:        _______ - _____ -__________                Date of birth:        _________     _______   ____________                

Drivers License:        State         _____________                Number:  ______________________________________                                  

Email Address:          _____________________________________________________________________

Amateur Station Information:                My station has / does not have emergency back up power for ____ hours / days.

Band                Fixed                Mobile        Portable                                Band                Fixed                Mobile                Portable

160                _____        _____        _______                                20                _____        _____        _______                                                                        

80                _____        _____        _______                                15                _____        _____        _______

40                _____        _____        _______                                10                _____        _____        _______

VHF

6                        _____        _____        _______                        220                _____        _____        _______

2                        _____        _____        _______                        440                _____        _____        _______

By my signature, I hereby agree to the above conditions and place my name forth for membership in the Lincoln County RACES program.  

Printed Name:        __________________________________

Signed Name:        __________________________________                Date:         ___________________________

_______________________________________________________________________________________________________________________________________                

Lincoln County NM Amateur Radio Emergency Service (ARES)                                                                

Application Form

I understand that the information contained herein will be kept confidential and will only be used in the management of the ARES program.  

Name:                                                        Amateur Call Sign:                        

        ________________________________                                ___________________

Address:                                                                                        

_____________________________________

City:                                                        State:                   Zip:                

_______________________________                _________                _______________ -   _____________

SS#:        _______ - _____ -__________                Date of birth:        _________     _______   ____________                

Drivers License:        State         _____________                Number:  ______________________________________                                  

Email Address:          _____________________________________________________________________

Amateur Station Information:                My station has / does not have emergency back up power for ____ hours / days.

Band                Fixed                Mobile        Portable                                Band                Fixed                Mobile                Portable

160                _____        _____        _______                                20                _____        _____        _______                                                                        

80                _____        _____        _______                                15                _____        _____        _______

40                _____        _____        _______                                10                _____        _____        _______

VHF

6                        _____        _____        _______                        220                _____        _____        _______

2                        _____        _____        _______                        440                _____        _____        _______

By my signature, I hereby agree to the above conditions and place my name forth for membership in the Lincoln County ARES program.  

Printed Name:        __________________________________

Signed Name:        __________________________________                Date: ________________________

_____________________________________________________________________________________________________________________

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