Northern Michigan Amateur Radio
 Emergency Services

" NMARES  "

Membership Application

This ARES  Emergency Contact Information will not, be shared with others without your permission!

 (please print legibly or type!)

 
Amateur Information

 

   Amateur Call Sign                                                Current License Class                              

         (or none)                                   (Novice, Tech, Tech Plus, General, Advanced,  Extra)                

 
_____________________/                                 ____________________________/                     
 

Check all that apply  ( X )                                      

Current ARES / RACES Member ?         CCECPSCO ?

  (      )  ARES   (      ) RACES               (      )                                                        

 NOAA SkyWarn Member ?                     Registered E-Spotter ?                          

(      ) Yes    (       ) No                           (      ) Yes    (       ) No                          

 
                County of  Residence
 

____________________________________/                               

 

Emergency Contact Information

 
        Last Name                                                                        First Name                  Middle Initial 
 

___________________________________/   ____________________________/    ________/   
 

       Number                              Street                                                               City     
 

__________________/   _______________________/     ___________________________/   
 

    State                       Zip Code - plus + four  

 

___________/            _________-_________/  

 
 Area Code - Home Phone                     Area Code - Work Phone                      
 

(         )______________________/   (          )__________________________/   


  Area Code   - Mobile Phone                     Area Code - Other Phone

(           )_________________________/  (_____)______________________/ 

 

            Area Code - Pager #

 
(_____)______________________/   
 

          Primary Email Address                                  Secondary Email Address               

___________________________________/     ___________________________________/          

Do you want to receive Group Email Announcements?                                                     

(      ) Yes     (     ) No


Check your contact preferences for  Emergency Nets such as
SkyWarn or Local Emergency Nets 


(     ) Daytime Only     (     )  Evening Only   (     ) Week Days Only    (     )  Weekend Only

(     ) Any Time 24 / 7        (    )  Do Not Contact for Emergency Nets     

(     )  Other Hours from ____________am/pm    to ___________ am/pm   


         Station Information

My Station has an Emergency Power Source  (    ) Yes  (    ) No      Bands -  (     ) HF    (     ) VHF   (    )  UHF 

I have  Mobile Station Operation    (    ) Yes  (    ) No    -  (     ) HF    (     ) VHF    (    )  UHF

I have  Portable Station Operation  (    ) Yes (    ) No    -  (     ) HF    (     ) VHF    (    )  UHF


Modes of Operation

(    ) CW    (    ) Phone  (    ) FM    (    ) AM   (    ) SSB     (    ) Packet    (    ) RTTY    (    ) PSK-31    (    ) SSTV     (    ) Satellite 

(    ) Remote Base   (    ) Repeater   (    )  Other  ___________  

(    ) Other _______________  (    ) Other ___________

 

Monitoring Practices

I routinely monitor the following FM simplex calling frequencies


(    ) 29.600 MHz  (    ) 52.525 MHz  (    ) 146.520 MHz  (    ) 223.50 MHz  (    ) 446.000 MHz

(    ) 902.10 MHz  (    ) 1294.50 MHz  (    ) 2305.2 MHz

(    ) Other simplex frequency -  Fill In   -  ___________________ MHz  __________ PL or DCS

 

I routinely monitor these local 2 meter repeaters

 

(    ) None                                  (    ) Petoskey 146.680 MHz       (    )  Cheboygan 146.740 MHz

(    ) East Jordan 146.280 MHz    (    ) Mancelona 146.380 MHz     (    ) Kalkaska 147.300 MHz

(    ) Traverse City 146.860 MHz  (    ) Cadillac  146.980 MHz         (    ) Mio 147.140 MHz

(    ) Grayling 145.130 MHz         (    ) Roscommon 145.450 MHz   (    ) Leland 147.390 MHz

(    ) Lewiston 145.190 MHz        (    )  Soo Canada 146.940 MHz   (    ) Pickford 146.640 MHz

(    ) IRA - Linked Repeater System      (    ) Gaylord 146.820 MHz

(    ) Other Repeater - Fill In          -  Input _________________  MHz ________ PL / DCS  
                                                             

                                                     Output ________________ MHz ________ PL / DCS

 
(    ) My repeater - Fill In               -  Input _________________  MHz ________ PL / DCS  
                                                             

                                                     Output ________________ MHz ________ PL / DCS


Other HF Frequencies, Bands  & Repeaters Monitored

 

(    ) Frequency - Fill In Information  -   Input _________________  MHz _______ PL / DCS  
                                                    

  Mode ______________________     Output ________________ MHz ________ PL / DCS

 

(    ) Frequency - Fill In Information  -   Input _________________  MHz ________ PL / DCS  
 

Mode ______________________        Output ________________ MHz ________ PL / DCS

   

(    ) Frequency - Fill In Information  -   Input _________________  MHz ________ PL / DCS  

  Mode ______________________      Output ________________ MHz ________ PL / DCS

  

Specialized Training & Certifications

 

FEMA (NIMS) Training:                                             Year /  Month / Date
 

Check if Completed

(    ) IS-00002 Emergency Preparedness USA     ________/______/_______

(    ) IS-00022 Are You Ready An Guide to Citizen Preparedness ________/______/_______ 

(    ) IS-00100 Introduction to Incident Command  ________/______/_______
 

(    ) IS-00200 Incident Command System Basic ________/______/_______
 

(    ) IS-00700 National Incident Command System (NIMS),an Intro. ________/______/_______
 

(    ) IS-00800 National Response Plan (NRP),an Introduction ________/______/_______
 

(    ) IS-00800.A   National Response Plan (NRP),an Introduction________/______/_______
 

(     ) Other FEMA (NIMS) Training - Fill In_____________________  ________/______/_______

 

ARRL Training                                     Description                      Year /  Month / Date

Check if Completed

(     ) Other ARRL  Training - Fill In _________________________    ________/______/_______

(     ) Other ARRL Training - Fill In _________________________    ________/______/_______ 

(     ) Other ARRL Training - Fill In _________________________    ________/______/_______
 

(     ) Other ARRL  Training - Fill In _________________________    ________/______/_______

 

ARRL  Appointments:

ARRL Volunteer Examiner                               Year / Month / Date

(     )  Yes    Certification Date   _____________/______________/_____________

ARRL Technical Specialist                              Year / Month / Date

(     )  Yes    Certification Date   _____________/______________/_____________

ARRL Official Observer                                    Year / Month / Date

(     )  Yes    Certification Date   _____________/______________/_____________

County Emergency Coordinator                       Year / Month / Date

(     )  Yes    Certification Date   _____________/______________/_____________
 

Other _____________________                      Year / Month / Date

(     )  Yes    Certification Date   _____________/______________/_____________

Other _____________________                      Year / Month / Date

(     )  Yes    Certification Date   _____________/______________/_____________
 

Tell us a little about your self such as:

Why do you want to join this group? Do you have any special interests or abilities? What do you do for a living, or in your retirement? How long have you been a Amateur? What  Amateur clubs or organizations do you belong too? What are your goals in Amateur Radio?  What can this group do to help you achieve you goals? How did you hear about our group? Have you visited our yahoo group site? What is your favorite mode of operation?


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Thank You for taking the time to complete the NMARES membership application! 

Your Membership's approval will be determined by the information you provide on this application.
 

You will be notified after your application is processed!  You don't need to be a Amateur to join in this groups activities.
       
Please pass this membership application along to anyone you feel might be interested in joining the NMARES group.

 

 The NMARES internet site is located at "http://groups.yahoo.com/group/nmares/ ".

( Their is no membership fee required to join this group )

 

Please return your application to

kc8nte@arrl.net

(e-mail submission is preferred)

Please include  "  NMARES Membership Application " in the E-mail Subject Line                                    


Or Mail to :               James E. Davis -  KC8NTE
                                         8378 VanTyle Road

                                     
Elmira, MI.  49730-9717                                                                                            
(rev 070306)