Kentucky ARES District 3 Station Appointment Application
Kentucky ARES District 3 Station Appointment Application:

This form is based upon ARRL Form FD-156. Please complete the entire form.

Before applying for a Kentucky ARES appointment, please read the job description.

Fields with a * are required and this form will not submit unless filled out.

By submitting this form, you attest that all information is complete and accurate.
Name:*
Email:*
Callsign:
License Class:
Address:
City/St/Zip:
County:
    
Day Phone:

Evening Phone:
Cell Phone:
ARRL Member:
 Yes No
Amateur Radio Organizations You Are A Member Of:
Please list the bands you can work: (Check all that apply)
Data:
 HF VHF/UHF 1.2 GHz
Packet:
 HF VHF/UHF 1.2 GHz
CW:
 HF VHF/UHF 1.2 GHz
SSB
 HF VHF/UHF 1.2 GHz
FM
 HF VHF/UHF 1.2 GHz
Other:
 HF VHF/UHF 1.2 GHz
Present ARRL Appointments:
Past ARRL Appointments:
Please describe your qualifications: (experience, and/or interests)