
Radio Amateurs of/du Canada
"We're ALL about Amateur Radio!" "Tous ensemble pour la radioamateur!"
Member Society of the International Amateur Radio Union
Field Services Organization
Public Service Activity Report
About This Form: Return to RAC ARES Pages
Each year Amateur Radio donates thousands of person-hours of supplementary public service communications during real emergencies, through simulated emergency tests and at events such as parades and marathons. Participation in these kinds of events shows Amateur Radio at its best. It is critically important that RAC bring documentation of this public service work to the attention of Industry Canada and other public officials. ALL such events, including those not involving RAC members or Services, should be reported. The information you provide on the form below will be an important addition to the records. Please complete and return this form to RAC Headquarters, 720 Belfast Rd, Suite 217, Ottawa, ON K1G 0Z5. Mark it to the attention of VP Field Services. Send a copy to your RAC Section Manager as well.
1. Nature of the activity (check one):
Communications
Emergency. Radio Amateurs supplied communications required to replace or
supplement normal communications means.
Alert. Radio Amateurs were deployed for
emergency communications, but emergency situation did not develop.
Special event. Radio Amateurs supplied
communications for a parade, race, marathon etc.
Test or drill. A training activity in
which Radio Amateurs participated.
2. Brief description of activity: ___________________________________________________________
3. Places or areas involved:______________________________________________________________
4. Number of Radio Amateurs participating: ____________
5. Event start date/time: _______________________ 6. Event end date/time:___________________

13. Nets and/or frequencies used (including repeater call sign):
__________________________________________________________________________________________________________________________________________________________________________________________
14. Number of messages handled: __________________
15. Names of agencies receiving communications support:
____________________________________________________________________________________________________________________________________________________________________________
16. Please list call signs of Radio Amateurs who were major participants:
17. Other comments:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please attach photos of Radio Amateurs in action, newspaper clippings or any other supporting data.
Location of your organization (municipality): __________________________________Province: ___________
Your name: _______________________________________________Call sign: ________________________
Address: ________________________________________________________________Postal Code_________
RAC appointment, if any: ________________________________E-mail: _____________________________
Telephone: Res: (____)___________________________Other:(____)_________________________________
"I attest that the information provided above is complete and true to the best of my knowledge."
Signature: _________________________________________________Date: ___________________________
FSD-157-R (Jul/06)