New Member Registration Form:

First Name:
Last Name:
Call Sign:
Mailing Address:
City:
State:
Zip Code:
ARES District:
Email Address:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Cell Phone Provider: Why we need this?
Occupation:
License Class:
Can your home station operate
without commercial power?

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-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?

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?