Name:

  

  

Call Sign:

  

  

Mailing Address:

  

  

City, State, ZIP code:

  

  ,  NC SC  

e-mail address(es):

  

Home phone number:

  

  

Work phone number:

  

  

Cell phone number:

  

License Class:

   Technician Technician + General Advanced Extra

Amateur Radio Clubs of Which you are a member of:  (If not in drop-down list please specify)

Select... Shelby Amateur Radio Club Cleveland County Amateur Radio Service Not Affiliated ARRL Only Other (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

MODE

HF

6 meters

2 meters

222 MHz

440 MHz

Others

  

SSB

  

  

  

CW

  

 

FM

  

     

 

  

DATA

  

 

 

PACKET

  

  

  

  

Mobile