Coshocton County Amateur Radio Emergency Service - ARES®

Registration Form

Name_____________________________________________________  Call_______________________

Address_______________________________________________________________________________

City/State/ZIP________________________________________________________________________

County_______________________  License Class_________ Email Adr_______________________

Home Ph___________________  Bus, Ph.____________________ Cell Ph._____________________

Pager_________________________

Underline All That Apply						   

Home Station 
CW        	HF	6	2  	440	Courses Taken:
SSB       	HF	6	2  	440		ARRL EMCOMM 
FM         	HF	6	2  	440		Level I   ____
RTTY	HF	6	2  	440		Level II  ____
PACKET	HF	6	2  	440		Level III ____
PSK31	HF	6	2  	440		FEMA
FAX	HF	6	2  	440		IS-100 ____
___________	HF	6	2  	440		IS-200 ____
___________	HF	6	2  	440		IS-700 ____
Battery	_____					IS-800 ____
Generator	_____					Other (List)
						__________________________________________
Portable Station					__________________________________________
CW        	HF	6	2  	440		__________________________________________
SSB       	HF	6	2  	440		__________________________________________
FM         	HF	6	2  	440		__________________________________________		
RTTY	HF	6	2  	440		__________________________________________		
PACKET	HF	6	2  	440		
PSK31	HF	6	2  	440		
FAX	HF	6	2  	440	Current ARES Badge	____		
___________	HF	6	2  	440	Current SkyWarn ID	____		
___________	HF	6	2  	440	Red Cross background check	____		
Battery	_____				ARRL Member (not req.)	____					
Generator	_____					

Mobile Station
CW        	HF	6	2  	440		
SSB       	HF	6	2  	440		
FM         	HF	6	2  	440		
RTTY	HF	6	2  	440				
PACKET	HF	6	2  	440		
PSK31	HF	6	2  	440		
FAX	HF	6	2  	440		
___________	HF	6	2  	440		
___________	HF	6	2  	440		
Battery	_____					
Generator	_____				

Signed________________________________________  Date___________

Mail To: CCARA  P.O.BOX 501   Coshocton,OH 43812