FSD-98 ARES Registration Form
For new and renewing ARES members.
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First Name: *
Middle Initial:
Last Name: *
Amateur Call Sign: *
License Class: *
Required
Mailing Address: *
City: *
State: *
Required
Zip Code: *
County: *
Which County do you live in? (Type the first letter of the County to narrow search.)
Home Phone Number: *
If no home phone enter "none"
Cell Phone Number: *
If no cell phone enter "none"
Work Phone Number: *
If no work phone enter "none"
Email Address: *
Kentucky ARES Map
District Number: *
Which district from the above map do you live?
Operational Bands: *
What frequency bands is your station capable of operating? Select all that apply.
Required
Operational Modes: *
What modes is your station capable of operating? Select all that apply.
Required
Can your station be operated without commercial power? *
Training: *
What types of emergency training have you completed? Select all that apply and provide certificates of listed training upon request.
Required
I attest that the information provided is complete and true to the best of my knowledge: *
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