Eastern Pennsylvania
District 2 EmComm

ARESŪ Registration Form

** Required Fields

Name **
Call Sign **
Address **
Address 2 
City **    State **    Zip **
email **
Home Phone
Work Phone
Cell Phone   Pager: 
License Class **
County **   ARRL Section: **  District: 


Can your home station be operated without commercial power?   Yes    No

Please List Equipment, and check all boxes that apply:

 Handheld Radio:
2 meters:  220 mHz: 440 mHz:
HF Radio:
Home: Mobile: Portable
VHF/UHF Radio:

Home:
Mobile:
Portable: 		Crossband 
Repeater capable:
Additional Radio:
Home: Mobile: Portable:             HF       or  VHF
Additional Supplemental Information -- Not required for Registration 
ARRL EmComm Classes completed:(Check EACH completed, not just the last level completed) Level 1 Level 2 Level 3

Have you completed FEMA IS-700 NIMS ? 		 
Yes     No 
CERT Training:  Yes     No 

Are you Familiar with Incident Command ?
Yes    No
IS-100   
IS-200 

Do you have a 72 hour "Ready Kit" Available ?
Yes    No
Click here for suggested  kit contents:

Do you have Portable Winlink capabilities ?
Airmail   
Paclink   
Telpac 

Do you have Portable HF antennas available ? 		 
Yes     No 
Describe:

Do you have a Portable generator that can be deployed with you?		  
Yes     No 
Please select a User ID and Password to be able to edit/update your information 
Please enter a User ID: ***    and Password:   ***   you can use to update this information at a later date.  

Add'l Comments: