Halton Amateur Radio Club

VE3OD - VE3THA - VA3HR

Serving Georgetown, Ontario, Canada

Halton Amateur Radio Club ARES Group *"We're ALL about Amateur Radio!" "Tous ensemble pour la radioamateur!"*
Amateur Radio Emergency Service Registration Form

Form Information Fields

First Name

Last Name

Home # (Enter 0's if N/A)
-- --

Callsign

Address

Work # (Enter 0's if N/A)
-- --

City/Town

Province

Cell # (Enter 0's if N/A)
-- --

Country

E-Mail

Fax # (Enter 0's if N/A)
-- --

Zip Code
-

Does you base station have emergency power?	Yes	no
Does your portable have spare batteries?	Yes	no
Have you ever been an ARES member before?	Yes	no
Briefly list info and/or ways you can assist ARES:

Check the bands/modes for your qualified operation	160 m	80 m	40 m	20 m	15 m	10 m	6 m	2 m	1.25 m	33 cm	23 cm	Check All
Portable/Handheld
Mobile
Base
CW
Phone
Packet
Other Digital

If applicable, identify and give full particulars of "Other Digital"