RADIO AMATEUR CIVIL EMERGENCY SERVICE
                             REGISTRATION FORM

 
     Name:____________________________________
    Call:___________________
    Address:___________________________________
    City:_____________________ State:___________Zip _____________________
     Bus. Phone:_______________Home Phone:_______________________________
    License Class:___________. Primary Radio Interest: _______________________
     County:_________________.
    Check (X) Bands/Modes you can operate:
        160___ 80___ 40___20___15___10___6___2___220___Other:____________
     CW:    ___
     FM:     ___
     RTTY: ___
     SSB:   ___
     MOBILE:___
     PACKET:___  DIGITAL MODES: _____________________________________________
     IF OPERATING PACKET, THE CALL SIGN OF YOUR PBBS Is:______________________
     Can you operate without commerical power  Yes___   No___
     If yes what bands ? _________________________________________________
     The State RACES organization supplements state and local government
     communications during disaster or emergency situations.
     By completeing and signing this registration form you are volunteering
       to be amember of the State RACES organization and are responsible for:
     1. Briefing the State RACES Officer of any changes in your equipment
          amater status that may affect RACES communications operations;
     2. Developing a strong background in emergency communications procedures
          and FCC Rules and Regulations;
     3. Being available when emergency communications are needed;
     4. Notifying the State RACES Officer, in writing, when terminating membership in
        RACES.
      Send completed form to:                         WILLIAM KORNEC
                                               MONTANA STATE RACES OFFICER 
                                                       PO BOX 965
                                                   LINCOLN, MT 59639
     Sign Here :______________________________________________Date______
     Office Use Only
     State RACES OFFICER-Signed_________________________________ Date______
     Approved:____                             Disapproved:____
     Administrator, DES-Signed__________________________________Date______
     Approved:____                             Disapproved:____

 
                                                             ANNEX E                                            K7LMT 4/7/97