ARES Edmonton Region Membership Registration/Renewal Form

Full Name:        Callsign:     

Mailing Address    

City, Postal Code    

Home Tel:       Cell Phone:            Cell Provider:  Bell Fido Rogers Telus (PCS) Telus (Mike) Virgin Mobile Other

Work Tel:     Ext       

Home Email:  

Work Email:   

Check bands and modes that you can operate:

Can you operate your home station without the use of commercial power?         Yes No

Comments

I understand that the information provided will be shared by other members of the ARES Edmonton Region Group for callout and contact. Also that my information will only be used for ARES purposes. I also understand that the primary role of ARES is to provide backup communications to Agencies when needed.