Milwaukie ARES (Mil-ARES) Roster Entry Form

Print and bring to meeting, or click on SUBMIT below, to send by e-mail.  (blue items optional)

CallSign Class Expires Example: 2/30/2006

Full Name      Last Name Only

1st Frequency Monitored   2nd Frequency Monitored   example: 147.380+ PL100.2

Home Phone Work Phone      Cell Phone    Alt. Cell       Pager

E-mail address      Alt. E-mail

Short Mail address   An e-mail address to your pager or cell for short text only

MailingAddress:    City: Zip:

Enter the street address only if different than your mailing address

StreetAddress:     City: Zip:

Date courses successfully completed, including refresher and update courses

ICS-100   ICS-200   ICS-700    First Aid   CPR

EC-001    EC-002      EC-003     OO            VE


Capabilities:

96-hr kit ready?   Able to serve in hardship conditions? code WPM?    Anderson connectors?

Vehicle: 4WD?   High Clearance/Trail Rated?   2m    70cm   HF?  

Base: 2m   70cm   HF    NVIS   Can you clearly copy the OEM in Salem?  
Hours (integer) of base station emergency power  

Packet: 2m   70cm   HF    NVIS   Can you clearly copy the OEM in Salem?


Other involvement or committment to other emergency response agencies? If none, put none.

Experience, history, comments or other data which didn't fit above


Information provided will be held as confidential and will not be distributed outside of ARES nor used for non-ARES purposes.