Worcester EmComm Team Membership Application
Fill out this form to apply for Worcester Emergency Communications Team membership.
Name
Your answer
Email Address
Your answer
Amateur Radio Call Sign (if none, put NONE)
Your answer
Amateur Radio License Class
Actual Street Address (do not use P.O. box)
Your answer
City / Town
Your answer
ZIP Code
Your answer
Mailing Address (if different, or use this if you are attending college in the area to specify your college address)
Your answer
Primary Telephone
Your answer
Primary Telephone Type
Secondary Telephone
Your answer
Secondary Telephone Type
Next
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