Form 1 Public Service Activity Report
For reporting use after each activity during your current month
Sign in to Google to save your progress. Learn more
1. Name of Amateur Radio organization providing service: *
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.
6. Call Sign of Amateur submitting report: *
7. Street Address: *
Address of Amateur submitting report
8. City: *
9. State: *
10. Zip Code: *
11. Telephone: *
Cell Preferrably
12. E-Mail Address: *
13. ARRL appointment, if any: *
Choose One
14. Nature of Activity: *
15. Nets Activated or Frequencies Used:
16. Event City: *
17. Event State: *
18. What types of agencies and/or organizations received support from Amateur Radio?: *
Check all that apply?
Required
19. Event Start Date: *
MM
/
DD
/
YYYY
20. Event Finish Date: *
MM
/
DD
/
YYYY
21. Event Start Time: *
Time
:
22. Event Finish Time: *
Time
:
23. Duration of event (hours): *
Round up or down using half hour increments.
24. Number of amateurs involved: *
25. Total person hours:
Multiply answer 24 x answer 23.
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
29. I attest that the information provided above is complete and true to the best of my knowledge.: *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy