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Susan Melvin, K4ZXN - Emergency Coordinator
Ben Melvin, KM4C - SKYWARN AEC  |  Todd Vickery, KG4UZT - Local Government Liaison AEC  |  Al Whatley, N4HAW - Net Operations AEC
Dewey Cook, KJ4BYU - Public Information Officer

 
Amateur Radio Emergency Service® of Cleveland County, NC
Registration Form
Sponsored by The Shelby Amateur Radio Club, Inc.
 
Name:
  
  
Date of Birth

Call Sign:
  
  
Mailing Address:
  
  
City, State, ZIP code:
  
   
e-mail address(es):
  
Home phone number:
  
  
Work phone number:
  
  
Cell phone number:
  
License Class:
  
Amateur Radio Clubs of Which you are a member of:  (If not in drop-down list please specify)
Training Completed:
 
You may apply without the training, however, you will be classified as non-certified until all FEMA Courses are satisfied.
ARECC Level I (Optional)  ARECC Level II (Optional) ARECC Level II (Optional)
 
FEMA:  All are required to be a certified member 
IS-100  IS-200  IS- 700  IS-800
  
Check bands and modes that you can operate:
  
MODE
HF
6 meters
2 meters
222 MHz
440 MHz
Others
  
SSB
  
  
  
CW
  
 
FM
  
     
 
  
DATA
  
 
 
PACKET
  
  
  
  
 
Mobile
  

  

  
  
  
  
  
  
  
  
Can your home station be operated without commercial power?   Yes       No
  
SignatureDate
  
Contact Emergency Coordinator, Susan Melvin, K4ZXN at k4zxn@arrl.net.
FSD-98 (07/04) Online Version developed by Susan Melvin for use on http://www.shelbyhamfest.org/ARES
 

 

Before submitting please print form out and either mail to EC or bring to meeting.

 

5/13/2008 - An Important Note from your EC regarding Cleveland County SKYWARN - Click Here (updated 8/19/2008)
This website Copyright © 2008 Shelby Amateur Radio Club, Inc. - All images on this website are property of K4ZXN / ARES of Cleveland County and the Shelby Amateur Radio Club.  Use of images and information from this site is prohibited unless permission has been granted by the author of this website.
Website Designed by K4ZXN - K4ZXN Website Design


ARES Amateur Radio Emergency Service LOGO IS A REGISTERED TRADEMARK OF AMERICAN RADIO RELAY LEAGUE, INC. used with permission.  SARC LOGO IS A REGISTERED TRADEMARK OF THE SHELBY AMATEUR RADIO CLUB, INC., used with permission.  SKYWARN TM LOGO IS A REGISTERED TRADEMARK OF NOAA, used with permission.