* denotes required fields

Personal Information

CALLSIGN:*

      State:*   Name:     DOB:*
              First Name*    Last Name*       


Station Capabilities

ASSIGNED
    
CAPABILITIES
    
COMPUTER
  
 ALE HF IBM
Patch AMP APPLE
PMBO VHF LINUX
FEMA GENERATOR NOPC
BST DEPLOYABLE HF   
SHARES DEPLOYABLE VHF RTTY     PACKET

Entered SHARES
 DEPLOYABLE DIGITAL AMTOR PSK31
       PACTOR MT63
    
G-TOR MFSK16
NTIA CLOVER SSTV


Emergency Communications Training


 FEMA 100     
FEMA 200     
FEMA 700     
FEMA 800
 
ECOMM1   ECOMM2   ECOMM3  

 

PRIVACY STATEMENT
 Privacy Act of 1974--Under the authority of 5 USC 301 and 10 USC 133, the information  requested on the Air Force MARS Application for Membership is for the purpose of establishing, renewal or modification  of MARS membership. The form is maintained as official Air Force MARS records. The information on this form will not be divulged without your written consent. Disclosure of the information requested on this form is voluntary. Failure to provide this requested information  may result in disapproval of the application or delays resulting from additional  research required to establish satisfactory eligibility.
GENERAL RELEASE -In considerartion of the permission extended to me by the United States through its officers and agents to engage in activities of the Military Affiliate Radio System, I do hereby, for myself, my heirs, executors and the administrators, remise, release and forever discharge the government of the United States, its officers, agents and employees, acting officially or otherwise, from any and all claims, demands, actions or cause of action, on account of damage to property and personal injuries, or death, suffered by me directly or indirectly resulting from my participation in the activities of the Military Affiliate Radio System. I certify that I will abide by all the governing rules and regulations now or hereafter prescribed by the Department of Defense for the Military Affiliate Radio System. (This release is not intended to apply and shall not be construed to apply to statutory rights of personnel in the military service, nor to any other rights of individuals under policies of life insurance (E.G. NSLI) or other forms of contracts with the United States.) 
Signature of Applicant*#
 
 

#Your typed signature indicates your willingness to abide by the rules and regulations of the USAF MARS program and that you attest that the inforntion on this form is accurate and correct to the best of your knowledge.  Providing false or misleading information may violate federal statute and may be punishable by fine and/or imprisonment. Information provided may be verified prior to processing of this application.