Name:         Callsign: 
 
  Address:      City:   State:   Zip: 
 
  Home Phone:   Work Phone:   Cell Phone:  
 
  Email:      

  Emergency or Civil Defense Organization Memberships:
  

  Weather Spotting Courses / Seminars / Workshops Training:
  

  Radio Equipment
  Base / Home (List radios, antennas, and emergency backup power capability, if any):
  

  Mobile Equipment:
  

  I will be available for storm spotting duty and reporting as follows:
   Mobile
   Base
   Home Via Internet or Phone
   Anytime Severe Weather Threatens
   Occasionally, on the following days and / or times: