CLARK COUNTY AMATEUR RADIO EMERGENCY SERVICE
Application for membership in Clark County Nevada ARES/RACES and authority to operate in the Radio Amateur Civil Emergency Service of Clark County, Nevada.
New application Renewal/Change of Information Send to: Bill Smith, W7HMV, 615 E. Eldorado Lane, Las Vegas, NV 89123
Name: ______LAST FIRST MI (PREFERRED/NICKNAME) Address: ______Physical Location/Cross Streets: ______City: ______State:______Zip:______
Call: Class: Expiration Date: ______/______/______ARRL Member VE (INFO ONLY - NOT REQUIRED FOR ARES/RACES) Notification (Check Primary Phone Number): Personal:
Home Phone: ______Height: ______Weight: ______
Work Phone: ______Hair color: ______Eye color: ______Fax: ______Sex: ______Date of Birth: _____/_____/______
Cellular Phone: ______Birth Location: ______E-mail: ______NV DL#: ______
Pager: ______Expires _____/_____/______
Voice ___ Numeric ___ Alphanumeric ___ Equipment/Capabilities: Base Mobile Portable Operate CW WPM ______144 MHz/2m c c c Portable Antennas (list): 440 MHz/70cm c c c Emergency Power: VHF/UHF HF Type: Dual Band/Crossband c c c Other Power (list): 900 MHz c c c First Aid certified CPR certified EmComm & ICS 50 MHz/6m c c c Courses: 28 MHz/10m Net Control/Traffic Experience: HF 80-10m Other Training (list): Packet c c PSK31 4 Wheel drive APRS RV/Motorhome RV/Trailer APRS Tracker Utility Trailer Other Equipment D-STAR (list): Radio Direction Finding Special Talents/Restrictions/Preferences (list): Computer FRS/GMRS/CB/Scanner (list): Year first licensed: I agree to abide by directives of the FCC, of the ARRL as they apply to ARES, and of the State of Nevada and Clark County Offices of Emergency Management as they apply to RACES, and that any authorization issued is with the express understanding that it is subject to revocation or cancellation by the Commission, ARRL, or in accordance with the State or County RACES Plans. I understand that I serve as a volunteer and am responsible for actions I take and that I serve without remuneration.
Signature of Applicant: ______Date:____/____/______***** A COPY OF YOUR LICENSE MUST BE ATTACHED ***** The privacy act of 1974, authority: Title 10, USC 3012. The information requested on this form is used to register you as an ARES/RACES member. This information will be used to publish rosters of amateur radio operators to be used by ARES and County Officials. Disclosure is voluntary, however, without it, registration will not be complete. ------I hereby certify that the applicant is a member of the local Emergency Management organization and has satisfied all requirements, both local and Federal, for the participation in the radio communications network for the area served by this organization. Approved by: ______Title: ______Date:____/____/______Approved by: ______Title: ______Date:____/____/______Rev 5/5/08 Thank you for applying for membership in Clark County NV ARES/RACES.
In order for us to make the best use of your talents and desires, please reply with answers to the following questions on your preferences, availability and training:
Which phone number should be listed as Primary?
What hours would you be available in case of an emergency?
Can you get off work for a true Emergency? Exercise?
How soon could you respond?
Are you in any other Emergency Organization that would affect your participation?
Are there any other factors that would affect your participation?
What Emergency Communications and/or ICS training have you had? Specify which courses completed & attach completion certificates and your license:
Are there any particular skills or capabilities you have that may enhance our organization?
Can we include you on the calling tree? As a caller?
Are there any particular agencies, cities or hospitals for which you would like to be a team member (list)?
Can we put you on a Rapid Response team for any agency/city/hospital (list)?
Would you be interested in being on a Mutual Aid Team that would travel to other counties to assist in their operations?
Are you willing to be a Net Control Operator for the Monday night and any emergency net?
Are you interested in participating in SKYWARN as a weather spotter? Current Spotter ID: Information at http://www.wrh.noaa.gov/vef/skywarn.php or Dave Blankenburg, AK7DB at [email protected]
We hold an ARES/RACES net at 7:30 PM on each Monday on the 147.18 (+) DPL244, 447.325 (-) PL100, 145.30 (-) PL100, and 147.18 (+) PL127.3 linked repeaters. We count on your participation.
To maintain your membership in Clark County ARES/RACES, completion of ARRL Emergency Communications Course Level 1 or the free Kentucky ARES Online Training Course within 12 months of joining ARES is required. For enrollment information in the ARRL course, see http://www.arrl.org/cep/calendar/ We strongly recommend that you also complete FEMA ICS courses 100a/200a/700a/800a. The FEMA and Kentucky ARES courses are free and available on-line at: http://training.fema.gov/IS/ and http://www.kyham.net/emcomm/training.html
If possible, please email a digital (.jpg preferred), passport-style photo of yourself to w7hmv at cox dot net for your ARES/RACES ID card.
Please be sure to notify me of any changes in your contact, availability and training information.
Any questions or comments?
Bill Smith, W7HMV ------Clark County NV ARES Emergency Coordinator Cell: 702-281-8894 Email: w7hmv at cox dot net Monitoring CC NV ARES Repeaters 147.18+ (DPL244)/447.325- (PL100) CC NV ARES: www.ccnvares.org