Linn County
AMATEUR RADIO EMERGENCY SERVICE
MEMBER SURVEY
Personal Information Date
Name Call Sign
Address License Class
City, Zip Home Phone
Home E-mail Work Phone
Work E-mail Cell Phone
Skills First Call List - I may be contacted 24 hours a day, 7 days a week to determine
Experienced if I am willing to assist a nearby county or to assist in an small scale emergency.
Willing to learn
Participation in "events" (walkathons, bike races, etc.)
Participation in Emergency Communications (including drills)
Severe Weather Spotter - I have received NOAA Training
Weather Radar operator (must be Collins employee)
Weather Radar liaison to other counties (need Radar receiver and 2m base)
Net Control - Traffic Net (e.g. Sunday night net)
Net Control - Events, Emergencies
Formal Traffic Handling – Voice Nets
Formal Traffic Handling – CW Nets
W0GQ Station Operation at the EOC
Communication System Repairs (willing to repair damaged equipment)
Resources 160 80 40 20 15 10 6 2 220 440 Other
SSB/CW Base
FM Base - - - - - -
SSB/CW Mobile
FM Mobile - - - - - -
FM Handheld - - - - - -
Mobile/Portable Direction Finding - - - - - -
Cross-Band Repeat Function - - - - - -
Specialized Communication Modes (eg. Echolink, IRLP, Packet, APRS, Winlink2000, Airmail)
Please list
Special Transportation
Boat Type with antenna, band(s) Marine Radio
Motorcycle with antenna, band(s)
Bicycle with antenna, band(s)
Snowmobile with antenna, band(s)
All Terrain Vehicle with antenna, band(s)
4-wheel Drive Vehicle with antenna, band(s)
Vehicle with Trailer Hitch - Please indicate class/ball size
Other Specialized Equipment
Portable Packet 115V 12V Battery Wireless Internet (e.g. Sprint, Verizon)
Portable Computer 115V 12V Battery Citizens Band Radio
Portable Printer 115V 12V Battery GPS Receiver
12V power supply Amps Video Camcorder
12V to 115VAC Inverter Watts
12V battery (portable) Amp-Hours
Portable Generator 115V Watts, 220V Watts, 12VDC, Amps
Portable Lighting
WX radar receiver Please call me when WX radar is up (so I can test my receiver).
Equipment to repair damaged commercial installations (test equipment, spare antennas, etc.)
Please return to Steve Jones, WA6GFD, 2990 19th Ave Marion, IA 52302 Version 3.2 – 6 February 2009