ccsaapp

Carter County Skywarn Association

On-Line Application

First Name

Middle Initial

Last Name

Address

City

State

Zip

Home Phone

Work Phone

Can you be contacted at work?

Cell Phone

Cell phone carrier.

Date of Birth

Do you have a valid Driver's License?

State of Issue.

Driver's License #.

Do you own a reliable vehicle?

Do you carry at lease liability insurance?

Do you own a two-way radio capable of operating within the public safety band?

Are you a licensed Amateur Radio Operator?

If so, what is you classification?

If you are an amateur, what is your call sign?

Have you ever received any storm spotter training?

Does this training include training from the National Weather Service?

If so, may we have a copy for our records?

Have you ever been convicted of a crime?

(If yes, please explain. You may omit: a) Traffic Violations, (Driving Under the Influence convictions must be reported); b) Any conviction committed prior to your 18th birthday which was finally adjudicated in Juvenile Court or under a youth offender law.)

If you have previous storm spotter experience, please list your prior affiliations and contact information below.

Please explain your interest in being a Skywarn Storm Spotter.

Please provide the names, address, and phone numbers of at least 3 individuals with whom you are acquainted.

Before membership acceptance, a thorough background check will be completed by Carter County Emergency Management.

By placing your name in the signature box below, you verify that the statements made within are true and correct, and agree that you are digitally signing this application.

Digital Signature

Date