SARC Emcomm Membership Information Form

PRIVACY NOTICE: All information you provide here will NEVER be disclosed to any outside companies or organizations. It will NEVER be made publicly available, and will NEVER appear on any publicly accessible internet web sites. This information is strictly for the use of the SARC Emcomm organization to work with you as an Emcomm volunteer.
Member Information:
Mr. Mrs. Ms.
First: Last: Call sign:
License Class Held:
E-mail address:

List phone numbers in the order you want us to call when trying to reach you for an emergency activiation:
1) Phone: (area code) (number)
2) Phone: (area code) (number)
3) Phone: (area code) (number)
4) Phone: (area code) (number)

Equipment and modes I have for Emcomm use: (Check all that apply)
HT -                HF      2m      220      440
Mobile rig -     HF      2m      220      440
Base (home) - HF      2m      220      440
APRS -   
ATV -     
Packet -

Emergency power I have for Emcomm use: (Check all that apply)
Portable Gel Cell (or similar) -     
Portable Generator -                      
Home QTH Gel Cell (or similar) -
Home QTH Generator -                 

Training: (Check all that apply)
ARRL Emergency Communications Course - Level 1      Level 2      Level 3     
SKYWARN training - Date of last SKYWARN training:
Registered with ARES -
Red Cross trained -       

Any other Emcomm related training:

Additional Information:
This section is provided for you to give us any emergency contact info you would like us to use ONLY in the event you become ill or injured while involved in an emcomm activity. This information is strictly voluntary and is only used to assist you in the event of an emergency.

Final Note to Volunteers: If you have any medical condition or concerns that you would like emergency medical personnel to be aware of if you became ill or injured during an emcomm event, please write up that information on a separate sheet of paper. Place it into a SEALED envelope with your name and callsign on it, and give it to a member of the emcomm committee at your first meeting or drill. This will be kept STRICTLY CONFIDENTIAL, and locked in the filing cabinet at the EOC. This envelope would only be opened for a medical emergency.

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