FSD-156 ARES EC, ADEC DEC Application Form
Application for Emergency Coordinator, Assistant District Emergency Coordinator or District Emergency Coordinator
You must hold an active ARRL membership to apply
1. Position for which you are applying:
2. First Name:
Your answer
3. Middle Initial:
Your answer
4. Last Name:
Your answer
5. Amateur Call Sign:
Your answer
6. Mailing Address:
Your answer
7. City:
Your answer
8. What Region of Tennessee do you live in:
Please refer to http://www.tnares.com/index.php/about-tnares if you are in doubt.
9. What Tennessee District do you live in:
Please refer to http://www.tnares.com/index.php/about-tnares if you are in doubt.
10. County:
What is your County of Residence?
11. State:
12. Zip Code:
Your answer
13. Home Phone Number:
If no number enter "none"
Your answer
14. Work Phone Number:
If no number enter "none"
Your answer
15. Cell Phone Number:
If no number enter "none"
Your answer
16. Email Address:
Your answer
17. License Class:
Required
18. Clubs:
List the name or names of clubs you are or have been a member of. If none, write "none".
Your answer
19. Auxiliary Power:
Can your home station be operated without commercial power?
20. Operational Bands:
What frequency bands is your station capable of operating on? Select all that apply.
Required
21. Operational Modes:
What modes is your station capable of operating on? Select all that apply.
Required
22. Training:
What types of emergency training have you completed? Select or list all that apply and provide certification of listed training.
Required
23. ARRL Member?
You MUST be an ARRL Member to apply
24. Present ARRL Appointment(s):
If no others write none".
Your answer
25. Former ARRL Appointment(s):
List all appointments you have held. If none, write "none".
Your answer
26. Describe related experience:
Describe experience you feel qualifies you for this position.
Your answer
27. I agree to complete all forms and reports required in a timely manner:
28. I attest the information provided is complete and true to the best of my knowledge:
Submit
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