| Name: |
Call: |
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| Address: |
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| City, State, Zip: |
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| Home Phone: |
Work Phone: |
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| Pager (digital or alphanumeric?): |
If alphanumeric, who's your provider? |
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| Email address: |
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| Packet address: |
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| Date of last NWS Spotter course: |
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| Location of last NWS Spotter course: |
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| What other ham radio groups are you a member of? |
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| What bands and modes are you capable of operating? |
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| Any other comments/suggestions/questions? |