Please accept this application for membership in the S.A.R.A. Inc. ( ) New ( ) Existing

( ) I am not interested in membership but would like to participate in Civil Preparedness functions.

( ) Iam already a member and this is only an update in the membership list for S.A.R.A. Inc.

Date of Application: __________

Name: ________________________________ ______________ ________________________ First - Middle - Last

Address: __________________________ __________________________ _____ ______________ Street Address - Town - State - Zip Code

Call: ________ Class of Call: _____ Phone Number (Home) _____________ (Work) _____________

The Southington Amateur Radio Association Inc. (S.A.R.A.) is actively involved in Public Service Events and Civil Preparedness. We ask all of our members to participate in whatever manner they can. Please take a moment to fill out the short questionnaire below. Indicate the areas that relate to your interests. (walk-a-thons, parades, most take place in the month of October and in the Spring.)

( ) I want to be involved in Civil Preparedness on a Club level.

( ) I also want to get involved with ARES and/or RACES.

( ) I have had emergency training, such as CPR, First Aid, EMT, etc.... Please list the training and the year that the training took place. ( ) I have a Four-wheel drive vehicle that I would be willing to use in times that would be needed by the Town/State (gas is free in times of emergency while you participate).

SPECIAL INTERESTS: The only way a club can serve its membership is to know each and everyone of you on a personal basis. The following are but a few items, please feel free to include any other activities and comments.

What are your favorite bands of operation?

What is/are your favorite mode/s of operation?

Are you involved with computers? ( YES ) ( NO ) In what manner and what kind?

Email Addresss:

Are you an ARRL. member ? ( YES ) ( NO ) We need this information, as we need 51% of our membership associated for us to remain affiliated)