This form is based upon ARRL Form FSD-157. If the text you are typing is longer than the form field, don't worry as the text will scroll as you type.

By submitting this form, you attest that all information is complete and accurate.
Name: Email: Callsign: Phone: ARRL Appointments:
Select Activity Type Communications Emergency Alert - Were on Stand By but situation didn't develop Event Training Exercise or Drill
Please give a brief description of the activity:
Places or areas involved:
Event Start Time/Date:
Event End Time/Date:
Event Duration in Hours: Total Person Hours:
Number of Repeaters Used:
Nets and/or Frequencies Used:
Estimated manpower cost: $ Person Hours x $19 per hour. Estimated cost of equipment used: $ Radios, Repeaters, other equipment. Total estimated cost of service: $ Total of above two fields.
Number of messages passed:
Agencies/Organizations Receiving Support:
List Callsigns of Amateurs Who Were Key Participants:
Name of Organization(s): (List city too)
Comments: