ARES Registration Form

    Please complete this form to become a member of Jackson County ARES. All fields market with an asterisk (*) are required and cannot be left blank. This information is private and will not be displayed or released to anyone. You may choose how much information is shared with your other ARES Members later.

    *Name:

    *Call Sign:

    *License Class:

    *Email Address:

    Mailing Address:

    City:

    State:

    Zip Code:

    *Phone Number - Primary:

    Phone Number - Secondary:

    Phone Number - Tertiary:

    HF Operation: (select all that apply)

    SSBCWFMPACKETDIGITALMOBILE

    6 Meter Operation: (select all that apply)

    SSBCWFMPACKETDIGITALMOBILE

    2 Meter Operation: (select all that apply)

    SSBCWFMPACKETDIGITALMOBILE

    222MHz / 1.25 Meter Operation: (select all that apply)

    SSBCWFMPACKETDIGITALMOBILE

    440MHz / 70cm Operation: (select all that apply)

    SSBCWFMPACKETDIGITALMOBILE

    Any other bands, modes, or special information you would like to include:

    Can your home station be operated without commercial power?

    YesNo

    What backup power methods do you currently have? (Please check all that apply)

    GeneratorBattery Backup (120v UPS)Battery Bank (12v)SolarWind