Registration Form Name: Call Sign
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Name: Call Sign
License Class: Check bands and modes that you can operate
Can your home station be operated without commercial power Yes [ ] No [ ]
Rensselaer County
ARES/RACES
Registration Form
Name:
Call Sign:
Mailing Address:
City, State, ZIP code:
e-mail address(es):
Home phone number:
Work phone number:
Cell phone number:
License Class:
Check bands and modes that you can operate:
MODE
HF
6 meters
2 meters
222 MHz
440 MHz
Others
SSB
CW
FM
DATA
PACKET
Other modes
(specify below)
Mobile
Operation
Can your home station be operated without commercial power? Yes [ ] No [ ]
Signature_____________________________________ Date ______________
Save this form and e-mail to:
rstein02@gmail.com
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