RADIO AMATEUR CIVIL EMERGENCY SERMCE

                          REGISTRATION FORM

 Name: 						Call:

 Address:
 City:                               State: 	Zip:
 Bus. Phone:             Home Phone:              County:
 License Class:             Primary Radio Interest:

 Check (X) Bands/Modes you can operate:
          160  80  40  20  15  10  6  2  220  OTHER
 CW
 FM
 RTTY
 SSB
 MOBILE
 PACKET
 IF OPERATING PACKET, THE CALLSIGN OF YOUR PBBS IS:


 Can you operate without commerical power [ ] Yes  [ ] No
 If yes what bands ?
 The State RACES organization supplements state and local government
 communications during disaster or emergency situations.

 By completeing and signing this registration form you are volunteering to be a
 member of the State RACES organization and are responsible for:

 1. Briefing the State RACES Officer of any changes in your equipment or amateur
    status that may affect RACES communications operations;
 2. Developing a strong background in emergency communications procedures and
    FCC Rules and Regulations;
 3. Being available when emergency communications are needed;
 4. Notifying the State RACES Officer, in writing, when terminating membership in
    RACES.

 Send completed form to: Montana DES Division
                         Attn: State RACES Officer
                         1100 North Main
                         Helena, MT 59620-2111


 Signed:__________________________________________________ Date:

                               ANNEX E