Richmond County REACTMember Application Please fill out as completely as possible. All information collected will be kept in confidence and to verify your identity. Name * First Name Last Name Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Birthday MM DD YYYY Birthday - Day and month We like to celebrate our member's birthdays Gender Male Female Prefer not to say GMRS Call Sign Amateur Radio Call Sign and Class ICS/NIMS Training: Check all you have completed through FEMA IS-100 IS-200 IS-700 IS-800 Other Training Check all you have completed. Basic CERT Advanced CERT Basic SKYWARN Advanced SKYWARN Emergency Contact * First Name Last Name Emergency Contact Address Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Phone * (###) ### #### I do hereby agree to abide by all rules and regulations set forth in the monitoring guide and the Constitution and Bylaws of Richmond County REACT Team #6269, Inc. I understand that upon my voluntary resignation of dismissal for any cause for this organization I will be obligated to return to the organization, within seven (7) days, all and any items which are the property of the organization, including but not limited to those which bear any officially recognized REACT International or Richmond County REACT Team identification. * Do you agree? Yes No I do hereby agree to all provisions of the application, and attest that all information contained herein is true and correct. * Do you agree? Yes No Type your legal name to sign the application. * Thank you!
