2020 ECS Member Info Form

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All ECS members must complete this form annually to become or remain an ECS member.
The information below is recorded automatically when you click on "Submit" at the end of the form.
Questions about this form can be directed by E-mail to training@k0ecs.org

Last Name *

First Name *

Middle Initial

Amateur Radio Call Sign *

Have you completed your Background Screening form and submitted it to the County? (for New Members Only) *

Yes

No, but I will do it prior to the February 28, 2020 deadline

License Class *

Technician

General

Extra

License Expiration Date *

YYYY

Home Street Address *

Home City *

Home State *

Home Zip Code *

Primary E-mail Address (Used for emergency and non-emergency notifications) *

Secondary E-mail Address (optional)

Primary Phone Number (Used for emergency and non-emergency notifications) *

Secondary Phone Number (Optional)

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