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About You

Last Name
First Name
Middle Initial


Street Address


City
State
Zipcode

Home Phone #
Work Phone #
Cell Phone #


E-Mail Address

About Your License


Your Callsign and Class of License

About Your Station

My home station can operate on the following bands/modes under Emergency Power:


160M
80M
60M
40M
30M
20M
15M

10M SSB
10M FM
6M SSB
6M FM
2M SSB
2M FM
70CM SSB
70CM FM


Type of Emergency Power:Available Amp/Hours if Batteries



My mobile station can operate on the following bands/modes:

160M
80M
60M
40M
30M
20M
15M


10M SSB
10M FM
6M SSB
6M FM
2M SSB
2M FM
70CM SSB
70CM FM





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ARES 2011