Radio Amateurs of/du Canada
THIS FORM IS AVAILABLE ONLINE FOR DOWNLOAD AND LOCAL PRINTING AT https://www.rac.ca/wp-content-uploads-files-ares-racfsforms/
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)
FSD-156R (12/08)