Form 1 Public Service Activity Report
For reporting use after each activity during your current month
1. Name of Amateur Radio organization providing service:
Your answer
2. What Region of Tennessee Do You Live In:
Please refer to http://www.tnares.com/index.php/about-tnares if you are in doubt.
3. What Tennessee District do you live in:
Please refer to http://www.tnares.com/index.php/about-tnares if you are in doubt.
4. County of origin:
What is your organization's home county:
5. Name of Amateur submitting report:
First Name, MI, Last Name, suffix if any.
Your answer
6. Call Sign of Amateur submitting report:
Your answer
7. Street Address:
Address of Amateur submitting report
Your answer
8. City:
Your answer
9. State:
10. Zip Code:
Your answer
11. Telephone:
Cell Preferrably
Your answer
12. E-Mail Address:
Your answer
13. ARRL appointment, if any:
Choose One
14. Nature of Activity:
15. Nets Activated or Used:
Your answer
16. Number of amateurs involved:
Your answer
17. Event City:
Your answer
18. Event State:
19. What types of agencies and/or organizations received support from Amateur Radio?:
Check all that apply?
Required
20. Event Start Date:
MM
/
DD
/
YYYY
21. Event Finish Date:
MM
/
DD
/
YYYY
22. Event Start Time:
Time
:
23. Event Finish Time:
Time
:
24. Duration of event (hours):
Round up or down using half hour increments.
Your answer
25. Total person hours:
Multiply answer 24 x answer 16.
Your answer
26. Frequency bands used:
Select all that apply
Required
27. Modes of communication used:
Select all that apply
Required
28. Other Comments:
Enter comments or drag and drop from Word
Your answer
29. I attest that the information provided above is complete and true to the best of my knowledge.:
Submit
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