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        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 County
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