GCECG Membership Application
	We would like to know some information about you, your background, training, skills and interests as they might relate to accomplishing the mission of the GCECG. It's a rather long form, but will be most useful to us. Thank you for taking the time to tell us about yourself. Basic Information   Name: Ham License Classification: Not Licensed Technician General Extra Callsign: Street Address: City and ZIP: Home Phone: Work Phone: Cell Phone: Pager: FAX: E-Mail: Web Site: Ham Experience In which year were you first licensed as a ham? Not Licensed 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 Before 1950 What is your current level of ham activity? Not Active Rarely Active Moderately Active Very Active What is the level of ham activity over your entire ham life? Not Active Rarely Active Moderately Active Very Active With which frequency band are you most familiar? None HF VHF/UHF Above UHF Check boxes for areas in which you feel that you have some experience: Power Supplies Antennas Masts / Towers Packet / Winlink Repeaters Schematics and Repair Deep Cycle Batteries Please check boxes for which you have capability: Mobile VHF Mobile UHF Mobile VHF/UHF Handheld VHF Handheld UHF Handheld VHF/UHF HF Traffic Net and Emergency Communications Experience Please note that this information is for us to get a full picture of your background. Lack of any of the below experience and training does not diminish your ability to help our group. Years Involved in traffic nets and/or emergency communications: None 0-1 Yr 1-2 Yr 2-5 Yr 5-10 Yr 10-20 Yr 20+ Yr Current level of traffic net / emergency communications activity: Not Active Rarely Active Moderately Active Very Active Total level of net/emergency comm activity over your entire ham life: Not Active Rarely Active Moderately Active Very Active With which nets have you been involved: Net control station experience: Knowledge level of formal message formatting (0=no experience, 10=true expert) 0 1 2 3 4 5 6 7 8 9 10 Actual experience level in formal message formatting (0=no experience, 10=true expert) 0 1 2 3 4 5 6 7 8 9 10 Involvement with ARRL's ARES: Involvement with FEMA's RACES: Involvement with other emergency communications: Check any ARRL EmComm courses you have taken: ARECC-1       ARECC-2       ARECC-3       Check any FEMA Incident Management System courses you have taken: IS-100       IS-200       IS-700       IS-800       Do you have ICS training?   Yes No Do you have NIMS training?   Yes No Have you studied ARRL's Public Service Communication Manual?   Yes No Do you have NCS experience for HF traffic or VHF tactical operations?   Yes No List any other training you have which is related to emergency communications: Electronics Experience other than ham Describe any non-ham electronics experience: Military/Business/Public Radio Communication Experience (non-ham) FCC Radio License: Years Involved: Describe: Exposure in Somewhat Related Fields (Leave each field blank if it does not apply to you) Describe your experience with: Mission Control / MER: Military: Law Enforcement: Fire Service: EMS Service: HAZMAT: Red Cross: Incident Command: Other Volunteer Service: Areas of Interest Check all that apply to you: Radio Operator at EOC during an Event Radio Operator Deployed in Field during an Event Teaching Emergency Communications Materials Recruiting Call-Out/Mustering Operators during an Event Radio Equipment Setup, Maintenance, Testing Practice Nets/Drills Administrative Functions: Web Site, Procedures, Records Administration, etc. Other Areas Generally, to what extent might you be available to assist at the EOC during an emergency, taking into account your work, family, and other needs? Generally, to what extent might you be available to assist at the EOC immediately after an emergency, taking into account your work, family, and other needs? Are you wanting to be a:      Full Member     Auxiliary Member        what these mean Background Check Authorization If you want to become a full member, click here to open the Background Check Authorization Form (in PDF format).  By printing, completing, and signing the form you authorize the Galveston County Office of Emergency Management to perform a cursory background check on you. This background check is required for all full members, since members have access to a county-owned facility. After completing the form, either Fax it to the number on the form, or mail it to the address on the form. If you are interested only in obtaining information about the group, e-mail the Director or Assistant Director by going to the "Contact GCECG" option available on the home page. Suggestions Do you have any questions, suggestions, or comments (other than making this form shorter)? Final Step When you press the "Send Data" button, the information you entered above will be automatically sent to the GCECG Director, who will contact you shortly after.  If you wish to clear the information and start over, press the "Clear Form" button.