Pinellas County Auxiliary Communication Services Application

Thank you for your interest in joining Pinellas County Auxiliary Communication Services.
Please take a few minutes to complete this Application.

Should you have any question, please call Neil at 727-242-5630 for more information
or email him at w4nhl.1@gmail.com


Name:
Callsign:
County of Residence:
Address:
Phone Number:
Email Address:
Class of License:	NOVICE CODELESS TECH TECH GENERAL ADVANCED EXTRA
Are you a ARES member:	YES NO IF NO, CHECK HERE IF YOU WANT TO JOIN CHECK HERE IF YOU WANT MORE INFO
SKYWARN PIN #:
Are you a ARRL Member?:	YES NO
ARECC Comm Courses Completed :
ICS/NIMS Courses Completed :
Are you a MARS Member?:	YES NO
If So, Which Branch:
Are you a SHARES Member?:	YES NO
Are you a CERT Member?:	YES NO
Do you own a HT:	YES NO
HT 2 meters:
HT 220:
HT 440:	YES NO
HT DUAL BAND:
HT TRI BAND:	YES NO
HT 1.2 Ghz:	YES NO
OWN A MOBILE RIG:	YES NO
M 2METERS:
M 220:
M 440:
M 1.2:
M DUAL BAND:
M TRI BAND:
M HF EQUPMENT:
M HF EQUPMENT:
OPERATE HF:	YES NO
HF 160:
HF 80:
HF 75:
HF 40:
HF 20:
HF 17:
HF 10:
HF 6:
HF 60:
HF OTHER:
What are your Ham Interests:
Do you own a 4 Wheel Drive:	YES NO
HEALTH DISABILITIES:
CAT TEAM:	YES NO
CAT COMMENTS: