Radio Amateurs of/du Canada

Member Society of the International Amateur Radio Union

 

THIS FORM IS AVAILABLE ONLINE FOR DOWNLOAD AND LOCAL PRINTING AT http://www.rac.ca/fieldorg/racfsforms.htm

 

ARES APPOINTMENT APPLICATION for

  DISTRICT or LOCAL EMERGENCY COORDINATOR

(Complete and send to your Section Emergency Coordinator)

 

Applicant must be -- and remain -- a RAC member in order to hold any RAC appointment in the Amateur Radio Emergency Service.  

 

Date Form Completed_______________________________________ Date Submitted to SEC_______________________________

 

 

                    Name _________________________________________________________________ Call Sign __________________________

 

                    Address_______________________________________________ County ________________________________________

 

                    City ________________________________________________________ Province ______ Postal Code ________________

 

                    Home phone   ____________________________________ Business phone _______________________________________

 

                    Place of Business  ___________________________________________Email:_____________________________________

 

                    Operating Qualifications Held  ______________________ Age (if under 18) ________ RAC Membership # / Expiry Date _________________

 

                    List Radio Club(s) of which you are a member _____________________________________________________________________________

 

                    ___________________________________________________________________________________________________________________

 

                    List the Amateur Bands on which you are active  ___________________________________________________________________________

 

                    List your present emergency equipment __________________________________________________________________________________

 

                    __________________________________________________________________________________________________________________

         

                    Present RAC appointments ___________________________________________________________________________________________

         

                    Former RAC appointments ___________________________________________________________________________________________

 

                    Why do you want to become a District or local Emergency Coordinator? _______________________________________________________

 

                    _________________________________________________________________________________________________________________

 

                    If you have had emergency operating experience or training, please provide FULL details (use other side if necessary).

 

                    _________________________________________________________________________________________________________________

 

                    _________________________________________________________________________________________________________________

 

                    ____________________________________        ____________________________   ______________________________

                    Applicant’s Signature                                          SEC Signature and call sign                  Date Appointed (SEC USE ONLY)

                                                                                                                                                                        (SEC, retain application for your records.)

FSD-156R  (12/08)