Iowa Repeater Council, Inc.
Member, Mid-America Coordination Council

This form is also available as a Microsoft Word®  Doc that you can fill out and e-mail to the Repeater Coordinator or use the Adobe ® PDF document for easier  printing. If you need the Adobe® PDF document print utility. Click this image:

Use this form to apply for the coordination of a frequency. All the blanks must be filled out, or the form will be returned to you. All the data is understood to be proposed, but remember that coordination is based on 5 criteria ( frequency, location, HAAT, ERP, and ownership). If any parameter is changed, coordinated status is lost and re-coordination must be done. If you propose to use link, control, or other frequencies, or have multiple receive sites, each frequency or site must have a separate form submitted.(* any confidential info)

Frequency or band under consideration: _______________________________________
Type of station (RPTR, CTRL LINK, AUX LINK, ETC): ____________________________
Station Callsign: _____________________ Trustee Callsign: ______________________
Located in/near this city: ________________________________________ (for directory)

Exact Location: N Lat: _____d _____m _____s;   W Lon: _____d _____m _____s

Xmtr Antenna HAAT: _________________  Rcvr Antenna HAAT: __________________
Power Out at Xmtr: _____________ Watts   ERP at Antenna: _______________ Watts
[see other worksheets for HAAT and ERP calculations]

Directory Info:

Access Modes: Open _____ Whistle _____ Sub Audible ______ Tone: _____________
Touch Tone ______ Sequence: ______________ Tone Burst ___ Tone: _____________
Autopatch? Open ____ Closed ____  AP Access: ______ = ON; ______ = OFF
Ringback on Autopatch? __________  Autopatch Phone No. ______________________
Direct Access to Law Enforcement (911) _________ Experimental _________________
Emerg. Pwr ______ Portable _______ RACES ______ RTTY/ASCII _____ AX.25 ______
Linked to other repeaters ____________________________________________________

Contact person Name: _______________________________ Callsign: _______________
Street Address/Box: ________________________________________________________
City: __________________________________ State: ______ Zip: ___________________
Day Phone: (______)______-__________ Evening Phone: (______)______-___________
E-mail Address: ___________________________________________________________
Sponsor (Person / Club, etc) if different: ________________________________________
Address info if different as above: ______________________________________________
_________________________________________________________________________

I acknowledge receipt of a copy of the Mid-America Coordination Council, Inc.,
Coordination Guidelines. I have read them and agree to abide by them and
cooperate with the Iowa Repeater Council, Inc., and the Frequency Coordinator.

Date: _________________ Submitted by: (PRINT) _______________________________
Signed: __________________________________________________________________
===================================================================

Please Return to:        Dennis W. Crabb, M.D. WBØGGI
                                 Frequency Coordinator
                                 Iowa Repeater Council, Inc.
                                 1306 4th Avenue North
                                 Denison, IA  51442
                                 (712) 263-5279 evenings
                                 E-mail: dwcrabb at frontiernet.net

©2ØØ6 Iowa Repeater Council, Inc.
All rights reserved.