United We Stand  

Brainerd Area Amateur Radio Club, Inc.

Emergency Service Registration Form

          Name:_________________________________________________________Call:______________

          Address:______________________________________City:_____________________Zip:_______

          Home Phone:_____________Work Phone:______________Cell Phone/Pager:______________

          E-Mail Address:________________________Packet PBSS Call Sign:______________________

          License Class:__________Primary Radio Interest______________________________________

          Check bands/modes you can operate:

      mode\band 160 80 40 30 20 17 15 12 10 6 2 1.25 70 33 23

 
  CW                                
  FM                                
  SSB                                
  RTTY                                
  Mobile                                
  HF                                
  Packet                                
                                   

          Can you operate your home station without commercial power?  (     )Yes     (     )No
          If Yes, what bands?________________________________________________________________

          Are you interested in being on the planning committee?  (     )Yes     (     )No

          Signature:_____________________________________________________Date:_______________

Questions?  Contact John Luce WØJGY
E-mail: w0jgy at arrl.net (replace the at with the familiar "@" sign.) 
The phone is (218) 963-4521 and his cell phone is (218) 820-3799.		 Print the form, fill it out, and mail it to: 
John Luce WØJGY
28045 Sunset Valley Road
Pequot Lakes, MN 56472

Back to the BAARC Main Page         Back to the Emergency Service Page

 This page was last updated 12/01/2007  Ø