Frontenac County Emergency Communications (Emcomm)

 

Membership Application Form

 

Name

 

 

Call Sign

 

 

Mailing Address

 

 

City, Province, and Postal Code

 

 

Email Address

 

 

Home Phone Number

 

 

Work Phone Number

 

 

Cell Phone Number

 

 

License Class

 

 

 

In Case of Emergency, Please Contact:

 

Phone:

 

Relationship:

 
 

 

 

 

 

 

 

 


Check bands and modes that you can operate:

 

Mode

HF

6 Metres

2 Metres

222 MHz

440 MHz

Other

SSB

 

 

 

 

 

 

CW

 

 

 

 

 

 

FM

 

 

 

 

 

 

DATA

 

 

 

 

 

 

PACKET

 

 

 

 

 

 

MOBILE

 

 

 

 

 

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Can your home station be operated without commercial power?  Yes  or No

(Please Circle)

 

 

Signature______________________________ Date_____________

Please Print out, complete in full, and give to the Frontenac EC.