AMATEUR RADIO EMERGENCY SERVICE

EMERGENCY CONTACT INFORMATION SHEET

The information on this form will be placed in Appendix D of the ARES Operations Manual. Appendix D will only be distributed to those agencies which are authorized to initiate an emergency response and which must contact a senior person in the ARES structure.

Persons completing this form must be prepared to accept an emergency call from such an agency, and lead an ARES emergency response.

Name
Callsign
Position
RAC member Yes
No
Radios 2m Handheld
2m Mobile
2m Portable Base
440 Handheld
440 Mobile
440 Portable Base
Home Phone Fax
Work Phone Fax
CMR(Cell)Phone Fax
Pager
Method
Internet
Radio
Home area Major N/S street
Major E/W street
Home address
Work area Major N/S street
Major E/W street
Work address
Other Info
Notes:
Enter your name and callsign where indicated, and the ARES position you hold, along with the territory. For each of the phone numbers (home, work, Cellular Mobile Radio("cellphone"), pager, fax) enter the complete number, including extensions, or N/A if you do not have such. For pager method, indicate the type of message: speech, touchtone, etc. If you have an Internet e-mail address, or a message can be relayed directly to you, enter that address. List the ham radio frequencies you tend to monitor. For Home and Work areas, give a major intersection, first a North/South street, then an East/West street, and give a complete mailing address.