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® PHILIPPINE CIVIL COMMUNICATIONS
CIVIC, AMATEUR RADIO COMMUNICATIONS GROUP
"Serving the Nation Thru Communications!"  
"Armed Forces of the Philippines Affiliated Reserve Unit"
International Organization
PHILCCOM Registration Form
Complete, print & sign then send by postal mail directly to your local Membership Coordinator or Chapter President.  

Name:

  
Callsign:  
Address:  
City/Town:  

Prov:

  
Postal:  
County:  
*Email:  

Res. #:

Work:

  

Cell:

  

FAX:

  
Do you have emergency power for your base station?
   Yes    No  

Do you have spare batteries for your portable?
   Yes    No  

 

Have you ever been a member of the PHILCCOM Group before? Yes    No    If Yes, give details.                                              

Briefly list other pertinent info and/or ways you can assist the Philippine Civil Communications:
Signature: 
Date: 

Check bands/modes of your qualified operation.

 160
m		 80
m		 40
m		 20
m		 15
m		 10
m		 6
m		 2
m		 1.25
m		 70
cm		 33
cm		 23
cm
Portable Handheld
Mobile
Base

CW
Phone
Packet

OtherDigital
RTTY
FSTV
Please mark above by clicking/checking relevant and applicable boxes.  If applicable, identify and give full particulars of "Other Digital". Thank you!
This Area for MC or CP Administrative Use Only:

Have Photo?

Licensed Ham?

Military Orientation Training Date
(DD-MMM-YY): 		Most Recent Civic Operation Participated In
(DD-MMM-YY):

Complete, print & mail to your Membership Coordinator (MC) or Chapter President(CP).  This information is required in order to assist the MC or CP in determining his/her local resources, thereby enabling optimum use of those resources. Information requested is solely  for purposes related to activities of the PHILCCOM INTERNATIONAL.  PHILCCOM is a community resource with a long history of public service originating with its inception in 1978. It has responded countless times to communications emergencies and experience has proven the worth of regular practice within an organized group.  Red Cross Training is highly desirable but not required for registration as a volunteer member, nor is possession of any special equipment. All Radio Amateurs can be of assistance to PHILCCOM INTERNATIONAL. To learn more about the PHILCCOM International and the 701st SBn, visit PHILCCOM INTERNATIONAL.