VOLUNTEER APPLICATION

VOLUNTEER FOR LYCOMING COUNTY

DISASTER COMMUNICATIONS SERVICE


Name:
Street:
City:
State:
ZIP:
Home Phone:
Work Phone:
Cell Phone:
Pager:
Email Address:
Call Sign:
License Class:
License Expire Date:
Emergency Notify:
Emergency Phone:

I hereby apply for membership as a volunteer in the Lycoming County Disaster Communicatiuons Service and agree to abide by the policies, rules, and regulations set forth in the DCS plan.