EmailMe Form - Marion County RACES Interest Form

Applicant Name *
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Email *

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Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Best Contact Phone Number *
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Current License Held *
Callsign *
Equipment Currently Available: *
2m HT
Base 2m
Mobile 2m
70cm (440) HT
Base 70cm (440)
Mobile 440
Base HF
Mobile HF
APRS
Pick all that apply.
Date Completed IS-100
MM / DD / YYYY
If you have not yet taken completed this course, leave the date blank. Do not put a date in the future if you are scheduled to take the course.
Date Completed IS-200
MM / DD / YYYY
If you have not yet taken completed this course, leave the date blank. Do not put a date in the future if you are scheduled to take the course.
Date Completed ICS-300
MM / DD / YYYY
If you have not yet taken completed this course, leave the date blank. Do not put a date in the future if you are scheduled to take the course.
Date Completed IS-700
MM / DD / YYYY
If you have not yet taken completed this course, leave the date blank. Do not put a date in the future if you are scheduled to take the course.
Date Completed IS-800
MM / DD / YYYY
If you have not yet taken completed this course, leave the date blank. Do not put a date in the future if you are scheduled to take the course.
Do you have field portable power?
This is any power source other than plugging into a wall socket.
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