Name: _________________________________________ Callsign: _______________

Date of Birth: ____/____/____

Address: ____________________________________________________

City:________________ State: _____ Zip: _________

Home Phone: _______________________

Cell Phone: ________________________ Cell Phone Carrier: __________

Would you like weather alert text messages? _________

Email Address: _______________________________________

Would you like to receive weather alert emails? __________

Vehicle Make: ________________ Vehicle Model: _______________ Vehicle Year: ___________

Vehicle Color: _____________ Vehicle License Plate #: __________________

Radio Equipment: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do you have any Weather Instruments that you use?_______

If so, what? ___________________________________________________________________

Do you have Emergency Power for Equipment? ____________

Have you taken a Skywarn™ Training Class in the last two years? _____________

If yes, What Year and Where? _____________________________________

Do you have a Spotter Number?________

If yes, what is your Spotter Number? ____________

I agree that I have provided the information above to the best of my knowledge. I understand that my information will not be given out to anyone unless I have authorized to do so. I also agree that if I am mobile spotting that at no time I can hold the Sandusky/Ottawa County Skywarn group that is part of Sandusky County A.R.E.S. responsible for anything such as injury, damage, or otherwise that may occur while I am mobile spotting.

X ____________________________________________________ _________________

Participant Signature Date