From the files of the ARRL Automated Mail Server, (info@arrl.org):
file: ecapp.txt    updated: 08-29-94

-----------------cut here-----------------------------------------

                        APPOINTMENT APPLICATION
                DISTRICT OR LOCAL EMERGENCY COORDINATOR
                        (to be sent to your SEC)
 
                                                Date________________________
 
Name________________________________________Call____________________________
 
Address_____________________________________County__________________________
 
City____________________________State_______Zip_____________________________
 
Home phone________________________Business phone____________________________
 
Place of business___________________________________________________________
 
License class____________Age________ARRL Membership expiration date_________
 
List names of Amateur Radio clubs of which you are a member:________________
 
____________________________________________________________________________
 
Are you active on 2-meter FM?           yes             no
 
Packet radio?                           yes             no
 
List your present emergency equipment_______________________________________
 
____________________________________________________________________________
 
Present ARRL appointments___________________________________________________
 
Former ARRL appointments____________________________________________________
 
Why do you want to become an emergency coordinator?_________________________
 
____________________________________________________________________________
 
If you have had emergency operating experience, please detail (use other side
if necessary).
 
_____________________________________________________________________________
 
_____________________________________________________________________________
 
_____________________________________________________________________________
 
 
______________________________                       ________________________
Date Appointed  (SEC Use Only)                       Signature and call
 
FSD - 156  (386)


