ARES

      Call:  Year First Licensed: 
 Last Name:    First Name: 
    Street:       Apt:   Nearest Cross St.: 
      Town:     State:  Zip: 
Home Phone:    Work phone:  Fax: 
     Pager:      Internet: 
License Class:Novice Technician Tech Plus General Advanced Extra

Indicate the bands/modes you can operate:

Emergency Power Type: 
Gas Generator    Duration:None. Less than 2 hrs. 2 - 5 hrs. 5-24hrs. 24-48hrs. 
LP Generator     Duration:None. Less than 2 hrs. 2 - 5 hrs. 5-24hrs. 24-48hrs.
Battery          Duration:None. Less than 2 hrs. 2 - 5 hrs. 5-24hrs. 24-48hrs.

Radio Interests:

Person to notify in case of illness (Name/Phone): 

SKYWARN 
Member:Yes  No  Skywarn #:   
Last Skywarn Training (Year, Month & Location if known):  

RACES 
The following is required for Suffolk County, NY RACES membership.  (New App. or Renewal)


1.)Copy of Amateur Radio License 
2.)Three (3) photographs.   (1. for county records, 1-for local records, 1-for ID Card)
3.)Copy of Completion Certificate of FEMA Home Study HS-2 or HS-7 is also required.


   Business Name: 
      Occupation: 
Business Address: 
U.S. Citizen:Y N  Marital Status:  Date of Birth:
Height:  Eye Color:  Hair Color:
Any previous military service? Y N
Ever convicted of a crime? Y N
Give details: 
Ever denied membership in any RACES organization? Y N
Give details: 
Last radiological training (Year & Month, if known): 
Character References (use call signs):
1:  2:
Are you part of any other Emergency Response Organization?  Y N
If yes, Organization & Position:  

Name: Date:

Print out the .pdf or Microsoft Word version of this application and hand it to Walter, KA2RGI at the next meeting or

send it as an email to tobares@optonline.net or

mail the application to:

Town of Babylon Amateur Radio Emergency Services
  P.O. Box 1222 
West Babylon, NY 11704