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 Frequencies Used:
Your answer
16. Event City: *
Your answer
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.
Your answer
24. Number of amateurs involved: *
Your answer
25. Total person hours:
Multiply answer 24 x answer 23.
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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