Membership Application
Fill out this form to apply for Worcester Emergency Communications Team membership.
* Name
* Amateur Radio Call Sign (if none, put NONE)
Amateur Radio License Class
* Actual Street Address (do not use P.O. box)
* City / Town
* ZIP Code
Mailing Address (if different, or use this if you are attending college in the area to specify your college address)
* Primary Telephone
* Primary Telephone Type
Secondary Telephone
Secondary Telephone Type
Work Telephone
* Email Address
* Do you hold any affiliation to any emergency management agency?  Yes
 No
If so, which agency, and to what capacity?
* Do you hold any ARRL ARECC certifications?  None
 Old Level 1 / New Basic
 Old Level 2
 Old Level 3
 New Advanced
List any FEMA ICS classes you've completed, if any
* Would you be interested in a regular NCS assignment?  Yes
 No
What aspects of emergency communications and amateur radio interest you?
Any comments that you wish to add?
* Age Verfication
 I am 18 years of age or older.
* Force Protection Form agreement
 I understand that in addition to this form I will be required to complete and return a Force Protection form to the City of Worcester. The form allows me and my family members I reside with to get innoculations during a pandemic outbreak within the first 24 hours of the incident (as per standards for disaster responders). I understand that by completing the Force Protection form my family and I are not obligated to receive innoculations and may refuse them any time they are offered.
* CORI Check Form agreement
 I understand that in addition to this form I will be required to complete and return a Criminal Offender Record Information (CORI) check form to the City of Worcester. I understand that the results of the form will be confidential to the City of Worcester and will not be shared with this organization other than a simple pass/fail result.
* denotes required field

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