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Emergency Notification System Questionnaire
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* Indicates required question
Name
*
Your answer
Email address
*
Your answer
Do we have your permission to contact you via email?
Choose
Yes
No
Sub Division name
Your answer
Would like to be a Point of Contact in your sub-division in an emergency?
Choose
Yes
No
Home address
Your answer
If you have a Ham license, what is your call sign?
Your answer
If you have a GMRS license, what is your call sign?
Your answer
Are you interested in getting your Ham or GMRS license?
Choose
Yes, Ham
Yes, GMRS
Yes, Both
No
Would you like to buy a radio for emergency use?
Choose
Yes
No
Comments or questions
Your answer
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