Thank you for your interest in joining Polk County ARES. Please take a few minutes to fill out this online application.


Call: 
Name: 
Address: 
City: 
State: 
Zip: 
Home Phone: 
Work Phone: 
E-mail Address: 
License Class: 
NOVICE TECH TECH PLUS  GENERAL ADVANCED EXTRA 
ARRL Member?  YES NO LIFE MEMBER
ARRL ARECC Courses:  Level I Level II Level III
VE Certification:  ARRL W5YI Other
Are you a permanent resident of the area?  YES NO 
If not a permanent resident, from  to 
Do you operate amateur HF?  YES NO 
If so, are you able to operate HF mobile?  YES NO 
Do you work VHF (2 Meters)?  YES NO 
If so, are you able to work VHF mobile?  YES NO 
Do you have portable VHF equipment (i.e., radios, extra batteries, antenna)?  YES NO 
Can your home station operate without commercial power?  YES NO 
Do you have APRS packet equipment?  YES NO 
Do you have any portable APRS equipment?  YES NO 
Do you have an APRS Weather Station? YES NO
Would you be available to work at an emergency shelter?  YES NO 
Are you available during weekdays for drills?  YES NO 
Are you available during weekdays for actual emergencies?  YES NO 
Are you available during weekends for drills?  YES NO 
Are you available during weekends for actual emergencies?  YES NO 
In the event of a disaster, would you be willing to travel out of the area to assist? (C.A.T. team)?  YES NO 
Are you interested in participating with other Amateur Radio projects, i.e.,  public service events, exhibits, etc.?  YES NO 

I have read and understand the information on this application. As an ARES member, I will operate in accordance to the plans and procedures set forth by Polk County Amateur Radio Emergency Services and/or the Polk County Emergency Coordinator, or his designated assistant(s).

Thank you for taking the time to register yourself to join Polk County ARES. When you click the "submit" button, this information will be sent to the Polk County Emergency Coordinator. In a few days, you should receive some further ARES information. Again, thank you for joining Polk County ARES.