ClayARES Membership Application
Application to join the Clay County Amateur Radio Emergency Service
County
*
Please Select
Clay
Date Submitted
*
/
Month
/
Day
Year
Date
Name
*
First Name
Last Name
Call Sign
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Amateur Radio License Class
*
Advanced
Amateur Extra
General
Novice
Technician
Email
*
example@example.com
Home Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mobile Phone Provider
Are you a member of any other local Amateur Radio Clubs / Organizations?
OPARC
NOFARS
Duval ARES
St Johns County ARES
Nassau County ARES
Other
Can your home station be operated without commercial power?
*
Yes
No
Available Operating Modes (Select all that apply)
*
VHF FM
VHF SSB
VHF CW
VHF Digital (Packet, etc)
VHF Mobile
UHF FM
UHF SSB
UHF CW
UHF Digital (Packet, etc)
UHF Mobile
HF SSB
HF CW
HF Digital (Packet, PKK, FT8, etc)
HF Mobile
Are you available for special events?
*
Yes
No
Are you available to deploy to local shelters? (some training is required)
*
Yes
No
Are you available to deploy within the Crown District (Clay, Duval, Nassau, Putnam, St. Johns)?
*
Yes
No
Are you available to deploy outside the Crown District?
*
Yes
No
Are you a CERT Member?
*
Yes
No
Have you completed any of the following ICS Courses?
*
IS-100 - Intro to ICS
IS-200 - ICS for Single Resource and Initial Action Incidents
IS-700 - Intro to NIMS
IS-800 - Into to National Response Network
None yet
Please provide any other pertinent details
Please verify that you are human
*
Submit
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