BASE MOBILE PORTABLE OTHER

PORTABLE GENERATOR
CAR BATTERY
SPARE CAR BATTERY

LONG POWER CABLE
FOR PORTABLE OPERATION
SOLAR POWER
HF BANDS

2M
220
440

SSB
AM
FM
CW
PACKET
RTTY
APRS (PACKET)
MAX POWER HF

MAX POWER VHF/UHF

TOTAL NUMBER OF XMITTERS

 

BASE

MOBILE

PORTABLE

OTHER

  
Please provide us with the following
information about yourself and your station: 

Are you a member of:

   SKYWARN   ARRL   ARES   RACES
I can operate my home station from emergency power:
HFYES
     NO
 VHFYES
         NO
In the text box at the left, Tell us anything about your station that is not included in the above information.


License Class:    N     T      T+      G       A         E
Call:
Name:
Address:
City: State:
Zip:
E-mail:
Home Phone:
Work Phone: 
Cell Phone:    
Personal Pager:     


When you have completed the above form, you may continue by clicking on the 'Submit' button to send your completed form to the Rensselaer County Emergency Coordinator - Tom Stewart, KC2FCR (EC)

If you want to reset or clear the form and start again click on the 'Clear Form' button

Designed by Tom Mathewson, KA2MYD