Polk County Amateur Radio Emergency Service Application

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Providing Support To Polk Emergency Management and Local Agencies!

ARES APP.

Thank you for your interest in joining
Polk County Amateur Radio Emergency Service .
Please take a few minutes to complete this Application.

Should you have any question, please contact the ARES EC Evans Mitchell, KD4EFM,
for more information email:


Name:
Callsign:
County of Residence:
Address:
Phone Number:
Email Address:
Class of License:	NOVICE TECH GENERAL EXTRA
Are you a ARES member:	YES NO IF NO, CHECK HERE IF YOU WANT TO JOIN CHECK HERE IF YOU WANT MORE INFO
Do you own a HT:	YES NO
For Which Bands?:	2 METERS 220: 440: 1.2 GHz: DUAL BAND: TRI BAND: DIGITAL VOICE:

Do you own a Mobile Rig?:	YES NO
For Which Bands?:	2 METERS: 220: 440: 1.2 GHz: DUAL BAND: TRI BAND: MOBILE HF:

Can You Operate HF::	YES NO
For Which Bands?:	160 Meters: 80 Meters: 75 Meters: 60 Meters: 40 Meters: 20 Meters: 17 Meters: 10 Meters: 6 Meters:


What are your Ham Interests:

Do you own a 4 Wheel Drive:	YES NO

Do you have any health problems or disabilities which might restrict your activity?

Are you available to assist on a Communications Assistance Team (CAT) in disaster areas elsewhere for periods of up to one week at a time?	YES NO




Have you submitted a Polk County Volunteer Application within the last year?	YES NO
Please enter any special comments related to "CAT" activities here

The links below are in text format:
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