Detroit
Area
Corvair
Club


Membership
Application
Form 		 


Please fill out all of the fields in the form below and click the submit button at the bottom of the page. The submitted data will be emailed to the DACC Membership Chairman, Clark Harzel membership@detroitcorvairs.com for processing. Clark will contact you (via email, preferably) if he has further questions regarding your application.

 

Contact Information
Name:
Address (Number & Street):
City: , Michigan
Zip Code:
County:
Home Phone:   Cell Phone:
Work Phone:
Primary Email Address:
Secondary Email Address:


Check the Bands and Modes that you are equipped to operate
Mode: HF 6-meters 2-meters 220 MHz 440 MHz Others...
SSB
CW
FM
DATA (PSK, Olivia, etc.)
Packet
Handi-Talkie
Mobile


Check your Sources of Backup Power, if any
    Battery Generator Solar/Wind
Must be Manually Connected (temporary):
Attached Full Time:
Automatic Transfer:
Can be used Portable:


Check any boxes that apply to your Portability/Go-Kit, if any
Have portable mast with ropes/guys/anchors:
Have portable antenna(s) and coax:
Have portable Power Supply:
Have portable Battery:
Have battery powered Lamp:
Have Headphones:
Have Resources (paper/pencil/logs/RadioGrams/FSD-212):
Are you equipped to operate PACKET:
Are you equipped to operate FLDIGI:
Are you equipped to operate WinLink:


Check any ID's, Licenses, and Crendentials that you hold
Drivers License: MI State MI State (Enhanced) Chauffeur Semi Hazardous Materials
Photo ID: State Federal Military Fire/Police Health/Medical Passport
Amateur Radio ID: ARES RACES ARRL Badge EOC Access
Other ID: Skywarn CERT


Check any FEMA/ICS/NIMS/ARRL/RedX Training that you have Completed
Basic Required Courses: IS-22 IS-100 IS-200 IS-700 IS-800
EOC Required Courses: IS-300 IS-400
ARRL Courses: EC-001 EC-002 EC-003 EC-016
Red Cross Courses: First Aid CPR Lifeguard
Disaster Action Team DSHR Member
(w/ID Card)		 Damage Assesment
Shelter Operations Shelter Manager Supervision in Disaster
Driver ERV Driver ECRV Operations


ADDITIONAL COMMENTS
Please provide any additional information that you feel will help expedite your application, or make clear any additional comments or needs.


Please click on the "Submit Form" button to send your information.
We will respond to your submission as soon as possible.