I, ___________________________________, would like to apply for membership in

                               (Print Name Clearly)

the Palos Verdes Estates Neighborhood Amateur Radio Team.

By completing the information below, I confirm that I support the mission of NART

and meet the qualifications listed here:

- Have a valid amateur radio license: _____________________  Class _____________

                                                                      (amateur radio call sign)                                                   

- Am 18 years of age or older

- Have a radio transceiver(s) with both 2 meter (144 MHz) and 70 cm (440 MHz).

Home Address:___________________________________________________________

Phone Number: Home _____________ Work ______________ Cell _________________

E-mail Address:___________________________________________________________

Normal At-Home Hours: ______________________ Are You Retired?  ____Yes _____No

Could you walk or bicycle to PVE City Hall?                                              ____Yes _____No

Equipment Information

Radios and capability: (please circle those that apply)

HT’s:     6m     2m     222 MHz     440 MHz     Type  ______________________________

Mobile:  6m     2m     222 MHz     440 MHz     HF (bands?) Other ___________________

Fixed:    6m     2m     222 MHz     440 MHz     HF (bands?) Other ___________________

Other Equipment: Home, Mobile (describe) ____________________________________

________________________________________________________________________

Antennas at your home, portable, and/or mobile: (describe) ________________________

________________________________________________________________________

Auxiliary Power: (describe) _________________________________________________

Other: (Communications capabilities, including digital, that might be useful in emergencies)

________________________________________________________________________

Shirt Size: (circle) men’s  S   M   L   XL

                              Signed: ______________________________            Date _________

                                                                   (signature)

CA 90274, or print, complete, scan and attach to an email to [email protected]).

NART Completion          NART No. ______        City or PD CRO Completion

NART application received  _____________                   DSW Registration Form completed ____________

Approval and advised by     _____________                   Sworn In with City of PVE (as DSW) ___________

Orientation Completed   __________  __________        ID Card Issued       ___________    ___________

& NART Manual received         (date)                  (by)                                                       (date)                       (by)