ARES Registration Form
Name:
Call Sign:
Mailing Address:
City, State, ZIP code:
e-mail address(es):
Home phone number:
Work phone number:
Cell phone number:
License Class:
MODE
HF
6 meters
2 meters
222 MHz
440 MHz
Others
SSB
CW
FM
DATA
PACKET
Other modes (
specify below)
Mobile Operation
Can your home station be operated without commercial power
?
Yes [
]
No [
]
Latitude and Longitude of your home QTH (if known.) _______________N _________________W
Signature_____________________________________
Date ______________
Please print this form and mail it to the Emergency Coordinator for your county.
Carroll County:
Haralson County:
Heard County:
Tim Tyson, KB4TIW
2943 Tyson Rd
Villa Rica, GA 30180-2980
Jon Mitcham, KD4YDA
805 Hamrick RD
Bremen, GA 30110
Glen Alford, KE4OBM
9157 Frolona RD
Franklin, GA 30173-3210