Online Registration

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:

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.