AMATEUR RADIO EMERGENCY SERVICES
REGISTRATION FORM
NAME CALL SIGN
ADDRESS
CITY COUNTY STATE ZIP
LICENSE CLASS PHONE NUMBER
E-MAIL ADDRESS ARRL MEMBER Yes No
Cellular Telephone Pager
AMATEUR OPERATIONS
6M 2M FM 220 MHZ 440 MHZ FM
HF VOICE APRS
2 M DIGITAL 440 MHZ DIGITAL
HF DIGITAL CW
AMATEUR RESOURCES
HT 2 M HT 440 MHZ HT DUAL
Emergency Power Mobile 2M Mobile 440
Additional Data or Comments
The Information you put in here will be sent to Irv Butler KB1E, EC for Lake CountyHOME
