GCECG Membership Application
We would like to know some information about you, your background, training, education, skills and interests as they might relate to accomplishing the mission of the GCECG. This form will allow us to conveniently gather needed information about you that you are comfortable in releasing, and to help you and us find the right areas for you to participate in. It is a long form, but will be most useful. Thank you for taking the time to tell us about yourself.
Basic Information Name: Ham License Classification: Not Licensed Technician General Extra Callsign: (Leave blank if not licensed) Street Address:
City and ZIP:
Home Phone: Work Phone:
Work Phone:
Cell Phone: Pager: Fax: E-Mail: Web Site: Ham Experience and Equipment In which year were you first licensed as a ham? Not Licensed 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 Level of knowledge and experience with the following areas (0=no experience, 10=true expert): Power Supplies: 0 1 2 3 4 5 6 7 8 9 10 Antennas: 0 1 2 3 4 5 6 7 8 9 10 Masts/Towers: 0 1 2 3 4 5 6 7 8 9 10 Breadboard / Home-Brewing: 0 1 2 3 4 5 6 7 8 9 10 CW Mode: 0 1 2 3 4 5 6 7 8 9 10 Packet and Winlink: 0 1 2 3 4 5 6 7 8 9 10 APRS: 0 1 2 3 4 5 6 7 8 9 10 Typing Speed: 0 1 2 3 4 5 6 7 8 9 10 Deep Cycle Batteries: 0 1 2 3 4 5 6 7 8 9 10 Electronic Test Equipment: 0 1 2 3 4 5 6 7 8 9 10 Please mark the boxes for which you have equipment that may be used during an event: VHF-FM UHF-FM WINLINK HF SSB HF CW HF PSK HF SSTV PACTOR PACKET Base/Fixed: Base/Fixed w/ Emerg Power: Mobile: Mobile Off-Road 4WD: Portable - Equipment Only: Portable - w/ Battery: Portable - w/ Generator: Portable - Antennas: Hand-Held: Scanner: Jump Kit for Rapid Deployment: RV or Trailer: 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
Pager: Fax:
E-Mail: Web Site:
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 Level of knowledge and experience with the following areas (0=no experience, 10=true expert): Power Supplies: 0 1 2 3 4 5 6 7 8 9 10 Antennas: 0 1 2 3 4 5 6 7 8 9 10 Masts/Towers: 0 1 2 3 4 5 6 7 8 9 10 Breadboard / Home-Brewing: 0 1 2 3 4 5 6 7 8 9 10 CW Mode: 0 1 2 3 4 5 6 7 8 9 10 Packet and Winlink: 0 1 2 3 4 5 6 7 8 9 10 APRS: 0 1 2 3 4 5 6 7 8 9 10 Typing Speed: 0 1 2 3 4 5 6 7 8 9 10 Deep Cycle Batteries: 0 1 2 3 4 5 6 7 8 9 10 Electronic Test Equipment: 0 1 2 3 4 5 6 7 8 9 10 Please mark the boxes for which you have equipment that may be used during an event:
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:
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
Have you studied ARRL's ARES Field Manual? Yes No
Have you studied chapters 7 and 8 in ARRL's Operating Manual, concerning traffic nets and emergency communications? Yes No
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
Electronics Experience other than ham
Describe any non-ham electronics experience:
Military/Business/Public Radio Communication Experience (non-ham) FCC Radio License:
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: Military: Law Enforcement: Fire Service: EMS Service: HAZMAT: Red Cross: Incident Command: Other Volunteer Service: Self-Assessment
Self-Assessment
Rate yourself in the following areas (0=no experience, 10=true expert or very senior experience and capability):
Are there any physical limitations or special needs that may affect what you can participate in?
Areas of Interest
Check all that apply to you:
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
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.
