Form AM-1 Form AM-1 Application to Operate a MARS Station

								OMB Control No. 0702-AAIP
								Experation Date: mm/dd/year
						US ARMY
						NETWORK ENTERPRISE TECHNOLOGY COMMAND (NETCOM)
						ARMY TELECOMMUNICATIONS DIVISION / MARS
						HF Gateway Station 90549 Jim Ave
						Fort Huachuca AZ 85613
						APPLICATION TO OPERATE A MARS STATION - FORM AM-1
Type of Application					Purpose of Application
		Individual Member				New		ID Card	If renewal, modification or ID Card : Call Sign of Current MARS Station
		Civilian Club Station				Renewal
		Auxiliary Member				Modification
Applicant Information (All Applicants Complete This Section)
	Last Name (or Club Name)					First Name				Middle Name
	Mailing Address					City		State		Zip
	Email					Home Phone		Work Phone		Cell Phone
Applicant Qualifying Information: (Individual and Auxiliary Members Complete This Section)
	An FCC License in the Amateur Radio Service is Required:				FRN or Amateur Radio Call Sign			Class of License		Expiration Date
	Prior MARS Service?				Prior MARS Service		Prior MARS Call sign		Prior Date of Service
	Are you more than 18 years of age AND a citizen of the United States?									YES	NO
	Check YES if the answer to any of the following questions is true: Explain any YES response on a separate sheet.									YES	NO
		Have you ever been convicted of a felony?					Are you currently under indictment in any court?
		Are you a current user of unlawful user of illicit drugs?					Are you associated with terrorist organizations?
		Have you ever been declared mentally incompetent?					Have you ever been discharged from the Armed Forces under other than honorable conditions?
Club Qualifying Information: (Club Applicants Complete This Section)
	Clubs require three active Army MARS members to be listed as part of the club station:
	Name and Call Sign of Club Custodian				Name and Call Sign of Member				Name and Call Sign of Member
Station Qualifying Information: (All Applicants Complete This Section)
	Do you have, or have access to a HF SSB transceiver capable of operating on all frequencies between 2-30 MHz?									YES	NO
	Is your station capable of transmitting and receiving using a approved data waveform? (Such waveforms include MIL-STD 188-110A Serial PSK, Wide Shift FSK (RTTY), Olivia, MT63 and Pactor)									YES	NO
	Do you have a computer with internet access?									YES	NO
Membership Agreement: (All Applicants Complete This Section)
	Participation in MARS is a voluntary activity undertaken by qualified amateur radio operator/citizens who contribute their time and use of personal communications equipment to achieve the objectives of the Department of Defense. The activity is strictly voluntary, and the US Government, Department of Defense, Department of the Army, or US Army NETCOM provide no compensation, reimbursement, insurance, or other benefits to volunteers. Volunteers are free to separate from MARS at any time. MARS is a structured organization and utilizes volunteers in leadership positions to direct, train and oversee activities. Members are authorized to operate on government radio frequencies; and are required to meet minimum qualifications, equipment and recurring training goals. MARS members will hold unclassified but sensitive information; the nature of Defense activities require high degree of personal discretion and professional conduct.
		I understand the voluntary nature of MARS and agree to utilize my personal radio equipment and contribute my time in support of the defense requirements of the United States, at my own risk and without compensation.
		I understand it may be necessary to modify my radio equipment to operate on government frequencies, to complete required training, to meet minimum participation requirements and to participate in ongoing training and exercise.
		I agree to share sensitive information only with authorized individuals whom have a need to know. I will not reveal sensitive information which has become known to me through MARS to unauthorized parties or in public forums.
		I will comply with all Army MARS rules, policies, regulations and directives; cooperate fully with the MARS volunteer leadership and staff, as well as the government officials and their contractors who have oversight of MARS.
					Privacy Act Statement
	Authority: 10 U.S.C. 3013, Secretary of the Army: DoD Directive 4650.2, Military Affiliate Radio System; Army Regulation 25-6, Military Affiliate Radio System. Purpose: To provide a potential reserve of trained radio communications personnel for military duty when needed and/or to provide auxiliary communications for military, civil, and/or disaster officials during periods of emergency. Routine Use: In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, the information contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: Information may be disclosed to Federal, State, and local agencies in connection with individual's participation in the Army MARS Equipment Program. The DoD ‘Blanket Routine Uses' set forth at the beginning of the Army's compilation of systems of records notices also apply to this system. Disclosure: Information is provided voluntarily; however, failure to provide identifying information may impede processing of this application and ultimate acceptance into the MARS program.
		Do you agree to publication of your name, address, email and telephone number on MARS rosters which may be made available to the general MARS membership?								YES	NO
		Do you agree to publication of your name and photograph in MARS press releases, newsletters, and social media for the proposes of recruiting and promoting MARS?								YES	NO
Certification (All Applicants Complete This Section)
	I affirm all information on this application is correct and any false statement may be cause to deny membership in MARS and the issuance of an Authorization to Operate. I understand I am required to notify US Army NETCOM ITSMD/MARS if there are any changes pertaining to the information on this form and further understand that failure to report such changes may be grounds for revocation of MARS membership and the Authorization to Operate.
	My signature on this form constitutes evidence of understanding and agreement to comply the terms of the membership agreement on this form.
	Signature						Date
		Internal Use Only	Applicant is: ACCEPTED		Applicant is: NOT ACCEPTED		Signature SMD / RD