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Highland Lakes Amateur Radio Club,Inc.(HLARC)
P.O. Box 856 Kingsland,Tx. 78639
Amateur Radio Emergency Service® Registration Form

NAME  
CALL  
ADDRESS  
CITY  
STATE  
ZIP  
E-MAIL  
HM PHONE  
WK PHONE  
OTHER  
LICENSE CLASS  
Can you operate without commercial power?
YES   NO  
What bands & modes Can you operate?
  HF 6M 2M 220 440 OTHER
FM            
SSB            
CW            
PACKET            
DATA            
MOBILE            
BASE            

Signature:_________________________________ Date:____________

Last updated January, 2007