DuPage County Amateur Emergency Radio Service, Inc

DCARES, Inc

ARES® Registration Form

Name:	Click or tap here to enter text.
Call Sign:	Click or tap here to enter text.
Mailing Address:	Click or tap here to enter text.
City, State, ZIP code:	Click or tap here to enter text.
e-mail address(es):	Click or tap here to enter text.
Home phone number:	Click or tap here to enter text.
Work phone number:	Click or tap here to enter text.
Cell phone number:	Click or tap here to enter text.
License Class:	Click or tap here to enter text.

Check bands and modes that you can operate:

MODE	HF	6 meters	2 meters	222 MHz	440 MHz	Others
SSB	☐	☐	☐	☐	☐	☐
CW	☐	☐	☐	☐	☐	☐
FM	☐	☐	☐	☐	☐	☐
DATA	☐	☐	☐	☐	☐	☐
PACKET	☐	☐	☐	☐	☐	☐
Other modes (specify below)	☐	☐	☐	☐	☐	☐
☐	☐	☐	☐	☐	☐
☐	☐	☐	☐	☐	☐
☐	☐	☐	☐	☐	☐
Mobile Operation	☐	☐	☐	☐	☐	☐

Can your home station be operated without commercial power? Yes ☐	No ☐

Signature: Click or tap here to enter text.	Date: Click or tap here to enter text.

Mail to DuPageCoARES, c/o Scott Palluth, 513 Woodhill Dr., Carol Stream, IL 60188 or

Email to DuPageCoARES@outlook.com