ESCAMBIA COUNTY AMATEUR RADIO EMERGENCY COMMUNITY REGISTRATION
Copy the form below into an e-mail, fill out the information and send to:
Jim Burrows N4LRM
and
Gene Bannon KB4HAH
Name:
Call Sign:
License Class:
Street Address:
City:
Zip:
Home Phone:
Work Phone:
Cell Phone:
2 METER INFORMATION (Indicate Y/N below)
2 Meter Capable:
2 Meter Emergency Power:
2 Meter Mobile (not HT):
HF INFORMATION (Indicate Y/N below)
HF Capable:
HF Emergency Power:
FEMA/ARRL Courses Completed (Indicate Y/N below
ICS-100:
ICS-200:
ICS-700:
ICS-800:
EC1:
EC2:
EC3:
Remarks: