ARES® Registration Form

Amateur Radio Emergency Service®

Name:		Call Sign:
Mailing Address:
City:		State:
ZIP Code:		Email Address(es):
Home Phone:		Work Phone:
Cell Phone:		License Class:

Check bands and modes that you can operate:

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

Signature:

Date: