NORTHWEST
EMERGENCY COMMUNICATIONS SERVICE
P.O. BOX
87 SPARTA, N.J. 07871
NAME: _______________________________ ADDRESS: _________________________________
PHONE: ______________________________ PAGER: ___________________________________
WORK: ______________________________ FAX: _____________________________________
CELLULAR: __________________________ E-MAIL: ___________________________________
PLEASE LIST ANY PUBLIC SAFETY/COMMUNICATIONS ORGANIZATIONS THAT YOU ARE A MEMBER OF/AFFILIATED WITH BELOW:
Please indicate the types of communications equipment that you possess, in the below section. Please be specific when listing “other” information.
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BASE |
MOBILE |
PORTABLE |
OTHER |
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CB |
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LOW BAND |
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HIGH BAND |
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UHF |
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800 MHz |
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SCANNER |
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OTHER |
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__ Emergency Warning Lights __ Fire Extinguisher __ Fire Safety Gear
__ First Aid Equipment __ Jumper Cables __ Other:
__ Amateur Radio License (Call Sign _____) __ GMRS License (Call Sign _________)
__ RACES Operator __ ARES Operator
__ Skywarn Spotter __ Other:
I, the above listed applicant, wish to become a member of the Northwest Emergency Communications Service. Upon becoming a member, I agree to abide by the Constitution, Bylaws, Standard Operating Procedures, and Emergency Operating Procedures of the organization. I agree to pay the required membership fees, as indicated in the Bylaws. I understand that violating the governing documents, or not paying membership fees will result in termination of my membership. I agree to return all issued membership materials upon resignation or termination of my membership.
Signature: ______________________________ Date: ______________________________
DO NOT SUBMIT ELECTRONICALLY.
PRINT, COMPLETE AND RETURN COMPLETED APPLICATION TO ANY NWECS SUPERVISOR
OR MAIL TO THE
ABOVE ADDRESS.