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["K8MCA"]
["Montgomery County, Ohio"]
["Amateur Radio Emergency Service® "]
[]
["           ARES® Registration Form - FSD-98"]
[]
[null,null,null,"New",null,"Change",null,"Current Year"]
[]
["Name (Last, First, MI):",null,null,null,null,null,null,"ARES ID #",null,null,"Date of Birth:"]
[]
["Mailing Address:",null,null,null,null,null,null,"Call Sign:",null,null,"License Class:"]
[]
["City, State, Zip Code:",null,null,null,null,null,null,"Home Phone Number:",null,null,null,null,"Primary"]
[]
["Prim. Email Address:",null,null,null,null,null,null,"Work Phone Number:",null,null,null,null,"Primary"]
[]
["Alt. Email Address: ",null,null,null,null,null,null,"Cell Phone Number:",null,null,null,null,"Primary"]
[]
[]
["Operating/Equipment Capability"]
[]
["Identify the communication modes that you have the capability to operate."]
[]
[null,"Voice","Home","Mobile","Portable","N/A",null,null,"Digital","Home","Mobile","Portable","N/A"]
[null,"HF",null,null,null,null,null,null,"APRS"]
[null,"VHF",null,null,null,null,null,null,"CW"]
[null,"UHF",null,null,null,null,null,null,"NBEMS"]
[null,"DMR",null,null,null,null,null,null,"Packet"]
[null,"D-Star",null,null,null,null,null,null,"Pactor"]
[null,"Fusion",null,null,null,null,null,null,"RTTY"]
[null,"Echolink",null,null,null,null,null,null,"Winlink"]
[null,"ATV"]
[]
[]
["Do you have HF Emergency Power Capability at home?"]
["Do you have VHF Emergency Power Capability at home?"]
["Emergency Callout Availability:        "]
["Do you have any disabilities that would prevent you from serving in the field?  "]
["If \"Yes\", can you serve as Net Control from your home?  "]
[]
[]
["CERTIFICATION / TRAINING"]
[]
["Identify any emergency communication, disaster management training or certifications you have.  Please submit copies of all certifications with the application. "]
[]
["ARRL Amateur Radio ",null,null,null,null,"EC-001","Date Completed:",null,null,"     FIRST AID",null,null,"Expires:"]
["Emergency Communication",null,null,null,null,"EC-002**","Date Completed:",null,null,null,null,null,"Expires:"]
["Certification (ARECC)",null,null,null,null,"EC-003**","Date Completed:",null,null,null,null,null,"Expires:"]
["(** Course Discontinued)",null,null,null,null,"EC-016","Date Completed:"]
[]
["FEMA"]
[null,"IS 100 Intro to the Incident Command System",null,null,null,null,"Date Completed:",null,null,"     ADVANCED ",null,null,"Expires:"]
[null,"IS 200 Single Resources & Initial Action Incidents",null,null,null,null,"Date Completed:",null,null,"     MEDICAL",null,null,"Expires:"]
[null,"IS 700 National Incident Management System",null,null,null,null,"Date Completed:",null,null,null,null,null,"Expires:"]
[null,"IS 800 National Response Framework",null,null,null,null,"Date Completed:"]
[null,"IS 802 Emg. Support Function (ESF) #2 Comms.",null,null,null,null,"Date Completed:"]
[]
["CITIZENS EMERGENCY RESPONSE TRAINING (CERT)",null,null,null,null,null,"Date Completed:",null,null,"     SKYWARN",null,"ID#"]
[null,null,null,null,null,null,null,null,null,null,null,null,"Date:"]
["OTHER (Specify)",null,null,null,null,null,null,null,null,null,null,null,"Date:"]
[]
[null,null,null,null,null,null,null,"     Do you want to subscribe to the Montgomery "]
[null,null,null,null,null,null,null,"     County Priority Traffic (MOCOPT) Mail List ?"]
[null,null,null,null,null,null,null,"     Please check subscription method."]
[]
[]
["Club Affiliations:",null,"American Radio Relay League",null,null,null,null,null,"Agency",null,"American Red Cross"]
["(Check all that apply)",null,"Centerville Amateur Radio Society",null,null,null,null,null,"Affiliations:",null,"Government"]
[null,null,"Dayton Amateur Radio Association",null,null,null,null,null,null,null,"Fire Department"]
[null,null,"Germantown Amateur Radio Society",null,null,null,null,null,null,null,"Law Enforcement"]
[null,null,"Huber Heights Amateur Radio Club",null,null,null,null,null,null,null,"Medical"]
[null,null,"Mound Amateur Radio Association",null,null,null,null,null,null,null,"Salvation Army"]
[null,null,"Mont. Co. Emg. Communication Team",null,null,null," ",null,null,null,"Search & Rescue"]
[null,null,"West Central Ohio Amateur Radio Assn",null,null,null," ",null,null,null,"Other (specify)"]
[null,null,"Other (specify):"]
[]
[]
["In signing the Montgomery County ARES® Application, it is understood that I must hold a valid Amateur Radio Operator License, possess a serious interest in providing"]
["emergency communications (community service) and committed to regular participation in meetings, nets, trainings, drills and community service events that will constitute"]
["the core group of prepared & ready-to-respond personnel.  "]
[]
[]
["Signature:",null,null,null,null,null,null,null,null,"Date:"]