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["K8MCA"]
["Montgomery County, Ohio"]
["Amateur Radio Emergency Service® "]
[]
["           ARES® Registration Form - FSD-98"]
[]
[{"$nulls":3},"New",null,"Change",null,"Current Year "]
[]
["Name (Last, First, MI):",{"$nulls":6},"ARES ID #",null,null,"Date of Birth:"]
[]
["Mailing Address:",{"$nulls":6},"Call Sign:",null,null,"License Class:"]
[]
["City, State, Zip Code:",{"$nulls":6},"Home Phone Number:",{"$nulls":4},"Primary"]
[]
["Prim. Email Address:",{"$nulls":6},"Work Phone Number:",{"$nulls":4},"Primary"]
[]
["Alt. Email Address: ",{"$nulls":6},"Cell Phone Number:",{"$nulls":4},"Primary"]
[]
[]
["Operating/Equipment Capability"]
[]
["Identify the communication modes that you have the capability to operate."]
[]
[null,"Voice","Home","Mobile","Portable","N/A",null,null,"Digital","Home","Mobile","Portable","N/A"]
[null,"HF",{"$nulls":6},"APRS"]
[null,"VHF",{"$nulls":6},"CW"]
[null,"UHF",{"$nulls":6},"NBEMS"]
[null,"D-Star",{"$nulls":6},"Packet"]
[null,"Echolink",{"$nulls":6},"Pactor"]
[null,"ATV",{"$nulls":6},"RTTY"]
[{"$nulls":8},"Winlink"]
[]
[]
[]
["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 ",{"$nulls":4},"EC-001","Date Completed:",null,null,"     FIRST AID",null,null,"Expires:"]
["Emergency Communication",{"$nulls":4},"EC-002**","Date Completed:",{"$nulls":5},"Expires:"]
["Certification (ARECC)",{"$nulls":4},"EC-003**","Date Completed:",{"$nulls":5},"Expires:"]
["(** Course Discontinued)",{"$nulls":4},"EC-016","Date Completed:"]
[]
["FEMA"]
[null,"IS 100 Intro to the Incident Command System",{"$nulls":4},"Date Completed:",null,null,"     ADVANCED ",null,null,"Expires:"]
[null,"IS 200 Single Resources & Initial Action Incidents",{"$nulls":4},"Date Completed:",null,null,"     MEDICAL",null,null,"Expires:"]
[null,"IS 700 National Incident Management System",{"$nulls":4},"Date Completed:",{"$nulls":5},"Expires:"]
[null,"IS 800 National Response Framework",{"$nulls":4},"Date Completed:"]
[null,"IS 802 Emg. Support Function (ESF) #2 Comms.",{"$nulls":4},"Date Completed:"]
[]
["CITIZENS EMERGENCY RESPONSE TRAINING (CERT)",{"$nulls":5},"Date Completed:",null,null,"     SKYWARN",null,"ID#"]
[{"$nulls":12},"Date:"]
["OTHER (Specify)",{"$nulls":11},"Date:"]
[]
[{"$nulls":7},"     Do you want to subscribe to the Montgomery "]
[{"$nulls":7},"     County Priority Traffic (MOCOPT) Mail List ?"]
[{"$nulls":7},"     Please check subscription method."]
[]
[]
["Club Affiliations:",null,"American Radio Relay League",{"$nulls":5},"Agency",null,"American Red Cross"]
["(Check all that apply)",null,"Centerville Amateur Radio Society",{"$nulls":5},"Affiliations:",null,"Government"]
[null,null,"Dayton Amateur Radio Association",{"$nulls":7},"Fire Department"]
[null,null,"Huber Heights Amateur Radio Club",{"$nulls":7},"Law Enforcement"]
[null,null,"Mound Amateur Radio Association",{"$nulls":7},"Medical"]
[null,null,"Mont. Co. Emg. Communication Team",{"$nulls":7},"Salvation Army"]
[null,null,"West Central Ohio Amateur Radio Assn",{"$nulls":3}," ",{"$nulls":3},"Search & Rescue"]
[null,null,"Other (specify):",{"$nulls":7},"Other (specify)"]
[]
[]
[]
["In signing the Montgomery County ARES® Application, it is understood that I must hold a valid Amateur Radio Operator License, possess a serious interest in providing"]
["emergency communications (community service) and committed to regular participation in meetings, nets, trainings, drills and community service events that will constitute"]
["the core group of prepared & ready-to-respond personnel.  "]
[]
[]
["Signature:",{"$nulls":8},"Date:"]