FSD-98 ARES Registration Form
For new and renewing ARES members.
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1. First Name: *
2. Middle Initial: *
3. Last Name: *
4. Amateur Call Sign: *
5. Mailing Address: *
6. City: *
7. What Arkansas District do you live in: *
8. County: *
What is your County of Residence?
9. State: *
10. Zip Code: *
11. Home Phone Number: *
If no number enter "none"
12. Work Phone Number: *
If no number enter "none"
13. Cell Phone Number: *
If no number enter "none"
14. Email Address: *
15. License Class: *
Required
16. Auxiliary Power: *
Can your home station be operated without commercial power?
17. Operational Bands: *
What frequency bands is your station capable of operating on? Select all that apply.
Required
18. Operational Modes: *
What modes is your station capable of operating on? Select all that apply.
Required
19. Training: *
What types of emergency training have you completed? Select all that apply and provide certification of listed training.
Required
20. I attest the information provided is complete and true to the best of my knowledge. *
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