ARES / RACES SURVEY FORM

WHAT IS YOUR NAME?

WHAT IS YOUR CALL SIGN?

COUNTY OF RESIDENCE?

Please give us your street address, your phone number (optional) and give any comments here.

Your e-mail address:

What class license do you hold?

NOVICE
CODELESS TECH
TECH
GENERAL
ADVANCED
EXTRA

Are you a ARRL Member?

YES NO
IF NO, CHECK HERE IF YOU WANT TO JOIN
CHECK HERE IF YOU WANT MORE INFO

Are you a ARES Member?

YES NO
IF NO, CHECK HERE IF YOU WANT TO JOIN
CHECK HERE IF YOU WANT MORE INFO

Are you a RACES Member?

YES NO
IF NO, CHECK HERE IF YOU WANT TO JOIN
CHECK HERE IF YOU WANT MORE INFO

Do you own an HT?

YES NO

Which Bands?

CHECK ALL THAT APPLY

TWO METERS 220 440
1.2 GHz DUAL BAND TRI BAND

Do you own a mobile rig?

YES NO

Which Bands?

CHECK ALL THAT APPLY

TWO METERS 220 440
1.2 GHz DUAL BAND TRI BAND
MOBILE HF EQUIPTMENT

Can you operate HF?

YES NO

Which Bands?

160 Meters 80 Meters 75 Meters
40 Meters 20 Meters 17 Meters
10 Meters 6 Meters OTHER


Other

What are your HAM interests?

ATV VHF SSB APRS PACKET
TRANSMITTER HUNTS DX EME SATELLITES
HF RADIO CONTROL OTHER


Other

Do you own a FOUR WHEEL DRIVE?

YES NO

Do you have any health problems or disabilities which might restrict your activity?

Are you available to assist on a Communications Assistance Team (CAT) in disaster areas elsewhere for periods of up to one week at a time?

YES NO

Please enter any special comments related to "CAT" activities here:

Thank You VERY much !

(All Done, click me)

(Clear everything and start again) If you have questions or comments about this website or ARES then click the mailbox to leave email to Gary Arnold, (WB2WPA) (garnold@naples.net).