Instructions:

1. Be sure to read the Frequently Asked Questions for guidelines about this form.
2. Fill out form below.
3. Review Final Page and Submit
Reserve 1x1 Call Sign:
Coordinator:
Beginning Date:
Date of planned Special Event Operation
Ending Date:
If more than 15 days contact coordinator first
Name of Event:
Ex: Memorial Dedication, ARC Field Day
Name or Name + Club Station Name:
As it appears on operator license
Current Call Sign / Club Call Sign:
As it appears on operator license
Current Mailing Address:
As it appears on operator license
Do not include your city, state, or zip
in this field.
City:
As it appears on operator license
State:
As it appears on operator license
Zip Code:
As it appears on operator license
Email Address:
Ex: mail@domain.com One email address only.
Daytime Phone:
Ex: (817) 555-1234 - do not leave your area code blank
Event Description / Additional Comments:
Describe the event and add additional comments for the coordinator if needed.