LOWNDES COUNTY ARES

MEMBERSHIP APPLICATION (Email form)

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For membership outside the Lowndes County, MS area contact:

1. For ARES: your local ARRL Emergency Coordinator (or the ARRL).

This is an application for :  ARES ( ARRL membership NOT required.)

Indicate bands/modes you can operate: Which have emergency power at your home station?

	160	80	40	30	20	17	15	10	6	2	220	440	900	1.2
ATV
CW
FM
RTTY
SSB
Packet
Mobile
Handheld
Emergency Power

      Call:   
 Last Name:  First Name: 
    Street:    Apt: 
      Town:  State:  Zip: 
Home Phone:  Work phone:  Fax: 
     Pager:    Internet: 
License Class:Novice Technician Tech Plus General Advanced Extra
Year First Licensed:
Radio Interests:

Person to notify in case of illness (Name/Phone): 

 Member:Yes  No

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The following is also required for RACES membership. Business Name: Occupation: Business Addr: U.S. Citizen:Y N Marital Status: Date of Birth: Height: Eye Color: Hair Color: Any previous military service? Y N Ever convicted of a crime? Y N Give details: Ever denied membership in any RACES organization? Y N Give details: Last radiological training (Year & Month, if known): Character References (use callsigns): 1: 2: Signature: Date:

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Either: application to by mail -OR- Snail mail application to: 1332 Sudduth Road, Steens, MS 39766

 

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Last Updated 1NOV11