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

Use this form to apply for the coordination of a remotely locatedreceiver as part of a larger repeater system.  It is understood that all data is proposed. Please fill in ALL the blanks.

Information Current as of: _______________ Town where located: ___________________
Receive Frequency: _______________         Rcvr Ant HAAT: __________________
Exact Location: N Lat: _____d _____m _____s; W Lon: _____d _____m _____s
Main transmitter site:   N Lat: _____d _____m _____s;  W Lon: _____d _____m _____s

Linked to transmitter site by wire: _________? or by radio: ____________?
If radio, give the following info (remember to coordinate the freq!)

Link Xmtr Freq: ______________               Link Xmtr Callsign: ________________
Link Xmtr Ant HAAT: __________             Link Antenna type: _________________
Power Out at Xmtr: ____________ Watts  ERP at Antenna: ___________________
[ see other worksheets for HAAT and ERP calculations ]

Link Control Modes: Sub audible ______  Tone: __________________________
                             Touch Tone ______  Sequence: _______________________
                             Other ___________  (specify):___________________________

Is there a Control Receiver associated with this remote location? _________ Y/N
If so, what frequency does it use? ____________________ MHz
(Remember, it too, must be coordinated to be protected.)

System Trustee:  Name: ___________________________     Call: _________________
                         Street: ___________________________________________________
                         City:    ___________________________ State: _____ Zip: ________
                         Day Phone: (________)____________________________
                         Night Phone:(________)____________________________

Sponsoring Group Name: ___________________________     Call: _________________
                           Street: ___________________________________________________
                           City:   ___________________________  State: _____  Zip: ________

Indicate which should receive into/mailings from the Council, the Trustee ____ or the sponsoring group _________.

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.

Completed by: (PRINT) _______________________________  Date: __________________
Signature: _________________________________________________________________
E-mail Address: _____________________________________________________________
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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
                             dwcrabb@pionet.net

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