Application to Join U.S. Air Force Military Auxiliary Radio System (MARS) E-Mail completed form, as an attachment, to: afnic.mars@us.af.mil and State MARS Director

or post hard copy to: HQ AF MARS

AFNIC/CYRS/SCM 203 W. Losey Street RM 1200

Scott AFB, IL 62225

Personal Information

Name:

Address

City State Zip Code

County/Parish Date of Birth (Must be over 18)

No If NO, are you a Resident Alien? Yes No

Home Phone: Work Phone: Cell:

DSN: E-Mail Address:

You may provide only my MARS call sign and state on the Regional MARS Web site.

Amateur Radio License Information

(Attach copy of your FCC Amateur Radio License)

Amateur Call Sign: Class: Expiration Date:

If Club Station, enter Trustee's Call Sign:

Type of Station: Personal Military Club

Privacy Act Statement

Privacy Act Statement: Under the authority of 5 U.S.C. 301 and 10 U.S.C. 133, the information requested on the Air Force MARS Application for Membership is for the purpose of establishing, renewal or modification of MARS membership. The form will be maintained as official Air Force MARS records. The information on this form will not be divulged to non-MARS members without your written consent. Disclosure of the information requested on this form is voluntary. Failure to provide this requested information may result in disapproval of the application or delays resulting from additional research required to establish satisfactory eligibility.

US Citizen? Yes

General Release

In consideration of the permission extended to me by the United States through its officers and agents to engage in activities of the Military Auxiliary Radio System, I do hereby, for myself, my heirs, executors and the administrators, remise, release, and forever discharge the government of the United states, its officers, agents and employees, acting officially or otherwise, form any and all claims, demands, actions or cause of action, on account of all damage to property and personal injuries, or death, suffered by me directly or indirectly resulting from my participation in the activities of the Military Auxiliary Radio System. I certify that I will abide by all the governing rules and regulations now and hereafter prescribed by the Department of Defense for the Military Auxiliary Radio System. (This release is not intended to apply and shall not be construed to apply to statutory rights of personnel in the military service, nor to any other rights of individuals under policies of life insurance (E.G., NSLI) or other forms of contracts with the United States.)

Air Force MARS Application Form, Page 1 Published 13 December 2011

Station Capabilities

High Frequency, HF (2-30 MHz, frequency stability of +/- 20Hz): Required for participation in Air Force MARS.

HF Frequencies:

Very High Frequency, VHF (136-174 MHz 12.5 KHz Channel Spacing)

VHF Frequencies:

RF Amplifier Phone Patch Repeater Emergency Power

Available to Deploy?

HF Voice VHF Voice

VHF Digital HF Digital

Digital Capabilities. Station capable of operating on at least one, High Frequency Digital mode (hardware or software) other then CW, is a requirement for participation in AF MARS.

Digital Mode Compliance

Type of Computer: Windows Apple/Mac LINUX None

RTTY AMTOR PACTOR G TOR

HF Packet

Clover

PSK-31 MT 63VHF Packet

MFSK 16

SSTV ALE

Other Modes

MARS Participation Are you currently a member of Army or Navy Marine Corps MARS?

Yes No

Have you ever been a member of Army, Navy-Marine Corps or Air Force MARS? If Yes, state service , call and dates.

Call:

Dates:

Applicant Signature

Service:

State MARS Director Approval

Region/Area MARS Director Approval

Air Force MARS Application Form, Page 2 Published 13 December 2011