A.R.E.S. On-Line Registration Form

Please use this form to submit your initial registration or to provide corrections/changes to your existing registration.

Please provide the following information:


           Name    Call Sign 
  Street Address 
 Address (cont.) 
            City   State/Province 
        Zip Code 
      Work Phone       Home Phone 
             FAX           E-mail

If you know your Geographic Coordinates, please provide them below.

Deg	Min	Sec	Deg	Min	Sec
		N			W

Select bands and modes that you can operate.

	160	80	40	20	15	10	6	2M	220	440	OTHER
CW
FM
RTTY
SSB
MOBILE
PACKET
APRS

Can your home station operate without commercial power? Yes No

Additional Information or Comments

Typed name here to serve as signature

Privacy Notice: This information is for the use of the Cherokee County Amateur Radio Emergency Service Group and will not be released to any other organization without your permission.