ARES Registration Form

Please complete this form to become a member of Jackson County ARES. All fields marked 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.

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Leave this empty

*Name:

*Call Sign:

*License Class:
Technician General Extra

*Email Address:

Mailing Address:

City:

State:

Zip Code:

*Phone Number - Primary:

Phone Number - Secondary:

Phone Number - Tertiary:

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HF Operation: (select all that apply)

SSB CW FM PACKET DIGITAL MOBILE

6 Meter Operation: (select all that apply)

SSB CW FM PACKET DIGITAL MOBILE

2 Meter Operation: (select all that apply)

SSB CW FM PACKET DIGITAL MOBILE

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

SSB CW FM PACKET DIGITAL MOBILE

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

SSB CW FM PACKET DIGITAL MOBILE

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

Can your home station be operated without commercial power?

Yes No

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

Generator Battery Backup (120v UPS) Battery Bank (12v) Solar Wind

Send