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New Member Registration Form:
First Name:
Last Name:
Call Sign:
Mailing Address:
City:
State:
Zip Code:
ARES District:
Select ARES District
Northwest
Southwest
Northeast
Southeast
High Desert
Unknown
Select Sub Zone
LA West
LA East
Valley West
Valley East
St. Clarita/Newhall
Unknown
Email Address:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Cell Phone Provider:
Cell Provider
AT&T
Cingular
Nextel
Sprint
T-Mobile
Virgin Mobile
Verizon
Unknown
Why we need this?
Occupation:
License Class:
Select License Class
No-License
Novice
Technician
Technician Plus
General
Advanced
Extra Class
Can your home station operate
without commercial power?
Select
Yes
No
Are you a SKYWARN Member?
Select
Yes
No
Check bands and modes you can operate:
Mode:
HF
6 Meter
2 Meter
220 MHz
440 MHz
Others
SSB:
CW:
FM:
Data:
Packet:
Mobile:
Other modes of operation or comments:
Please mark any of the training courses you have completed:
ARRL Emergency Communications:
Level 1
Level 2
Level 3
FEMA:
IS-100
IS-200
IS-300
IS-400
IS-700
ICS-800-B
ICS-800-Other
Red Cross:
CPR
First Aid
Mass Care
L.A. Fire Department:
CERT Level 1
CERT Refresher
How familiar are you with standard radiogram traffic-handling procedures?
Select
Not Familiar
Some Knowledge/Experience
Comfortably Familiar
Expert
Other relevant training (list):
What training would you like to see in a group/class setting?
Do you have any special skills (technical, medical etc.) or resources
(test gear, fabrication, printing etc.) that may be helpful to our organization?
Are you a member of any other public-service organizations (list):
What are your main goals for your involvement with ARES?
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Los Angeles Section Northwest District Amateur Radio Emergency Service
