Please be sure to read and understand the ACS Membership requirements before submitting your application.
Type of Application:
New
Update
Call:
Name:
Address:
Address2:
City:
State:
Zip code:
Home Telephone Number:
Cell Telephone Number:
E-mail:
Year first licensed:
License Class:
Technician
Technician Plus
General
Advanced
Extra
Full Time Resident:
Yes
No
If not a full time resident, from to
Please indicate if you've had any of the following training classes:
CERT (County Trained)
CERT IS-317
ARRL ARECC Level I
ARRL ARECC Level II
ARRL ARECC Level III
ICS I-100
ICS I-200
ICS I-300
ICS I-400
I-700/NIMS
I-703/NIMS Resource Management
ICS I-706
I-800
During deployments, specific equipment may be needed. Please list any equipment (radios, antennas, other capabilities, etc.) that you could provide for ACS use during a deployment.
Our assignments include Special Needs Shelters (PSN), Red Cross Shelters, and Tactical First In Teams. Shelters are opened on an "as needed" basis. Shelter openings may vary with each emergency.
Please select your preferred assignment. We will assign you a specific location as needed for each activation.
Sarasota Area Special Needs Shelter
North Port Area Special Needs Shelter
Sarasota Area Red Cross Shelter
Venice Area Red Cross Shelter
North Port Area Red Cross Shelter
Sarasota Area TFIT
Venice Area TFIT
North Port Area TFIT
Any as needed
Availability (times, days, etc., you are available)
Please include any additional comments or information, such as special skills, special requests, additional training, etc.
I have read and understand the ACS membership requirements.
