AMARS Region 9 Contact / Capabilities Survey

This form is intended for use by AMARS Region 9 Members to assist in maintaining current contact information and data on your capabilities / availability. Please complete the following questionaire supplying all of the information you can. You should also use this form to report changes in information previously supplied.

Information supplied on this form is only for use by Region 9 Staff and State Directors. Questions regarding the privacy of personal data should be directed to AAA9RD, the Region 9 Director.

* = Required Information Version 0.15
 
Personal Data
* Is this an update to a prior Registration? Yes
No
* AMARS Callsign:
  Authorization to Operate Expires: mm/dd/yy - same as Amateur License expiration
  Billet Callsign: (if applicable)
* Amateur Callsign:
* Last Name:
* First Name:
  Middle Initial:
  Nick Name:
* MARS eMail Address:
  Alternate eMail Address:
 
 
Contact Information
  Mailing Address:
  City:
  County:
  State:
  Zip Code:
  Telephone
Numbers:
Home:
Work: Ext:
Mobile/Cell:
* Preferred
Method
of
Contact:
Home Telephone
Work Telephone
Mobile/Cell Telephone
Other:
  Text Alerting

If you want to be included in the Region 9 SMS Text Alerting System, please provide your Mobile number in the question above and provide this information.
Cellphone Service Provider: ATT/Verizon/Sprint/etc.

SMS Alias, if used:

Entering this data will allow you to be added to the system if it operates in your area.
 
 
Personal Time Availability
* Normal Availability Hours:

Please indicate those hours in local time when you are most likely to be available Monday through Friday.
0001-0600
0601-1200
1201-1800
1801-2400
Other
 
 
Equipment / Software Availability
Check only items in operting condition
  Home (Fixed) Station; HF Radio   Power Watts
HF Amplifier   Power Watts
Dual HF Radio Capability
MARS VHF
M110A: M110A Modem     M110A Software
Pactor: Pactor III     Pactor IV
ALE: ALE Radio     Software ALE
Packet: AX.25 TNC - TNC Model
              AX.25 Software Based
Phone Patch
Other
  Mobile (Installed or Portable): HF
MARS VHF
Other
  Handheld: MARS VHF
Other
  Emergency Power: Home Generator KW
Portable Generator KW
Portable 12V Battery
Other KW
  Antennas: HF: HF Vert - Bands 75/60/40/30/20 M
       HF Beam - Bands 40/30/20 M
       HF Wire Ant - Bands 135/95/75/60/40/30/20 M
VHF: Describe

Other: (Describe)
 
 
WINLINK / Monitoring
  Are you an active registered AMARS WINLINK User? Yes
No
  Do you normally monitor a MARS or Amateur frequency? If so, enter: MARS MHz.
Amateur MHz.
 
 
FEMA / ICS Training
  FEMA Classes FEMA IS-100 - Intro to ICS
FEMA IS-200 - ICS for Small Resource Incidents
FEMA IS-700 - Intro to NIMS
FEMA IS-800 - Intro to NRF
 
 
General Capabilities
Check the level of your ability
  HF Experience: None Low Medium High
  Electronic Repair Experience: None Low Medium High
  Ability to Install Antennas: None Low Medium High
  Programming HT's: None Low Medium High
  Generator Experience: None Low Medium High
  Computer Skills: None Low Medium High
  Foreign Languages: Read Speak
Read Speak
 
Please list any additional applicable equipment or skills here:
 
 
Comments:
 
 
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