Southwest Virginia
Hospital Preparedness
Commission
Amateur Radio Operator
Registration Form
Name
Call Sign
License Class
E-Mail Addess
Home Phone
Business Phone (Optional)
Cell Phone
Street Address
City
State
Zip
Hospital Assigment
Click on One
Health Department Assignments, You may click on One
Click helow if you would be willing to serve as part of a "Roving Team" to cover hospitals or health centers outside of your home area.
Click on "Reset" to erase the form and start over.
Click on "Submit" to have your form set to the Webmaster and join the Hospital Communications Team
Click Below if you wiould be willing to serve as a Communications Officer or Asst. Communications officer
Technician
General
Advanced
Extra
Lee County Medical
Wellmont-Lonesome Pine
Norton Community
St Mary's
Wellmont -Holston Valley
Johnson Memorial
Smyth County Community
Russell County Medical
Clinch Valley Medical
Buchanan General
Tazewell Community
Twin County Regional
Wellmont-Bristol Regional
Wythe County Community
LENEWESCO-Wise County Health
Cumberland Plateau Health Dept.
Mt Rogers Health Department
YesNo
YesNo