Assistance Questionaire * = Required Information

Call Sign:   (If you have one)

First Name:*

Last Name:*


 (view our privacy policy)

Your State/Area:*

Are you an active scout leader? i.e. Scoutmaster, Browies Leader
      No        Yes
Youth group name: (i.e. troop 123, Atlanta Council)

Are you a badge counsel for a youth program?
      No        Yes

Does your area have an existing Radio Scouting Program?
      No        Yes

Could you assist us in restarting the Radio Scouting program in your area?
      No        Yes

Could you be a club representative in your area? (To help us get hams involved in your area.)
      No        Yes
Club Name: (i.e. ABC Ham Club)