A.R.C.A. Repeater Frequency Coordination Application Form
Please See Instructions

New Coordination:   Relocation of Existing:   Modification of Existing: 

Band: 10m 6m  2m  222  420  440  902  1240  Microwave

Section 1 -- Repeater Information 

Repeater Call:        			Repeater Location:      
Output Freq:       				Input Freq:        

Transmitter Power:       Watts.		System ERP:       Watts 

Emission:     			Check equipment specs for actual Emission type

Latitude: N        ‘    ”	(DD/MM/SS) 	Longitude: W         ‘    ”  (DDD/MM/SS)

Site Elevation Above Sea Level:      ft      Antenna Elevation - Above Ground:    ft  
 
Manufacturer and model of the transmitting antenna:      .

Antenna Gain (dBd):    	Polarity:   	Pattern:        	Bearing:     °

Mountain Top Site:      HAAT:       Repeater Geographic Area: 

Repeater Type Codes: 
This application is for a LINK 		Portable: 
Closed/Private:     Autopatch:     Closed Autopatch:    Emergency Power: 
Races:    	Television:  
Linked:   	Remote Base  	
VOIP Link:    Type: Echolink  Node #      	IRLP Node #      
 Access:  Tone / Code/ DPK / PL:       	  	LTZ:    	DTMF: 
Remarks or additional information:     

Section 2 – Single Point of Contact for Coordination Related Communications 

Name:         						Call:      

Address:           

City:       						State: AZ  	Zip:      

Email:      

Telephone (Day):      				Telephone (Evening):      

Section 3 -- Site Information and Location 
(Include Site Agreement or letter from site owner giving permission to install with this application.)

Address / Location of Site:      

Site Owner or Manager Name:      

Site Owner or Manager Phone:      

Site Owner or Manager Address:      

Site Owner or Manager City:      		State:     Zip:      

Site Owner or Manager E mail:      

Section 4 – Repeater Sponsor / Owner / Club

Name:       						Call:      

Address:      

City:      						State:    Zip:      

Email:      

Telephone (Day):      		Telephone (Evening):      
Section 5 – Licensee

Name:      						Call:      

Trustee (if applicable):            			Call:      
Address:      
City:       						State:    Zip:      
Email:      
Telephone (Day):      		Telephone (Evening):      

Estimated date when station will be on-the-air:       

Signature:      	Date of Application:      

Please send completed form to the coordinator for the appropriate band listed on the coordinators website (http://www.azfreqcoord.org/coord.html), 
or e-mail it to:  coordinators@azfreqcoord.org