Seminole ARES/RACES Membership Application 2019
Seminole County ARES®/RACES, in cooperation with the Seminole County Department of Public Safety and Division of Emergency Management, provides Amateur Radio emergency communications, augmenting normal lines of communication during emergencies or pending disaster. We also provide volunteer communications services for Public Service events.
Application Type *
Callsign *
Your answer
Nick Name
The name your friends call you. This is the name that will show on the roster.
Your answer
First Name *
Legal name that appears on your lisnece.
Your answer
Middle Initial
Your answer
Last Name *
Your answer
Address *
House number and street name. (no PO Boxes)
Your answer
City *
Your answer
Email Address (primary) *
Your answer
Alt. Email
Your answer
Primary Phone Number (home) *
xxx-xxx-xxxx
Your answer
Work Phone
xxx-xxx-xxxx
Your answer
Cell Phone
xxx-xxx-xxxx
Your answer
Other Numbers
xxx-xxx-xxxx home fax
Your answer
ARRL Member? *
If yes, please list any appointments.
Your answer
License Class *
First year Licensed *
Your answer
Do you have any family members that are licensed? *
Please list callsigns if they are local.
Your answer
Employer or Occupation *
Your answer
Can you get off work without penalty? *
If you employer only allows you off work during a local disaster please select yes.
Does your employer require a letter from the EC to allow time off from work? *
Do you work for an Emergency Management Agency? *
Explain
Your answer
Training
Please explain and list any certificate numbers below.
Please list any special skills or training
CW speed, SkyWarn spotter number, etc.
Your answer
Are you fluent in any foreign languages? *
Please list any below or type none
Your answer
ARRL EmComm Training *
Required
FEMA Training *
Required
Transportation *
Required
Do you have an at home station? *
Required
Do you have a portable or mobile station? *
Required
How long can you run on emergency power? *
Additional Capabilities
Do you have a portable computer or any other special hardware/equipment?
Your answer
Do you have any limitation for medical reasons, your job, or transportation?
Please Describe
Your answer
Additional Interests *
Are you interested in being apart of any of these teams with in our group?
Required
Zone Number *
What zone number best describes where you live? 100 Sanford and Lake Mary (Volusia), 200 Apopka and Altamonte Springs (Lake), 300 Longwood, 400 Casselberry and Fern Park , 500 Winter Springs and Winter Park(Orange), 600 Oviedo, Geneva, and Chuluota
Background
Membership in the Seminole ARES/RACES group is dependent on your ability to participate in any activities if you choose work. Any applicants who the county determines cannot work in the Emergency Operations Center, a shelter, or any other sensitive location because of problems in their background check, as determined by the served agency, will not be accepted as a member of the Seminole ARES/RACES Group.
Felony / First Degree Misdemeanor *
If Yes, please explain in detail.
Your answer
Signature (type your callsign) *
I understand that I must hold a valid Amateur Radio License, and that giving false information on this registration could result in my immediate disqualification from Seminole ARES/RACES Group.
Your answer
I understand that Seminole ARES/RACES may verify the information provided to ensure it is true and accurate. *
Required
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