ACS Membership Application

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
ICS I-700
ICS I-703
ICS I-706
ICS I-800
ICS I-802
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 may include General Population Shelters, Special Needs Shelters (PSN), Tactical First In Teams, among others.

Please select your preferred assignment. We will assign you a specific location as needed for each activation. Members just joining with none of the training requirements will be assigned to shelters until they become eligible for other assignments.
Sarasota Area Shelter
Venice Area Shelter
North Port Area Shelter
Sarasota Area Special Needs Shelter
North Port Area Special Needs Shelter
Sarasota Area Tactical First In Team
Venice Area Tactical First In Team
North Port Area Tactical First In Team
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.

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