HARC-logo 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"