Lycoming County ARES Registration Form
Name *
Call Sign *
Address 1 *
Address 2
City *
State
Clear selection
Zip
Home Phone *
Work Phone
Cell Phone
E-Mail Address
License Class: *
Band that you can operate
Please Check All That Apply
HF Modes that you can operate
Please Check All That Apply
VHF/UHF Modes that you can operate
Please Check All That Apply
Do you have backup power?
Clear selection
I have the following NIMS certifications
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy