Form AM-1 Application to Operate a MARS Station

APPLICATION TO OPERATE A MARS STATION - FORM AM-1
Please read Agency Disclosure Notice, Privacy Act Statement, and Instructions prior to completing this form.

If renewal or modification:
Call Sign of Current MARS Station

Purpose of Application
Renewal

New

Applicant Information

OMB No. 0702-0140
OMB approval
expires 03312023

Modification

(All Applicants Complete This Section)
Middle Name

Last Name

First Name

Mailing Address

City

State

Zip

Email

Home Phone

Work Phone

Cell Phone

Applicant Qualifying Information:

(All Applicants Complete This Section)

Amateur Radio Call Sign

Class of License

Prior MARS Service

(Army, Air Force, Navy MARS)

Prior MARS
Service?

Expiration Date

Prior MARS Call sign
(if known)

Prior Date of Service

IF YES
YES

NO

Have you read AR 25-6 and AM1 documents?

You must read before you speak to an Army MARS Leader. If you check No, Army MARS
Headquarters will refer you back to these documents to read.

Are you 18 years old or older?
Are you a citizen of the United States?
Check YES if the answer to any of the following questions is true:
Explain any YES response on a separate sheet.
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 discharged from the Armed Forces under other
than honorable conditions?

Have you ever been declared mentally incompetent?

Army MARS- Individual Application, December 2022

PREVIOUS EDITION IS OBSOLETE.

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Station Qualifying Information: (All Applicants Complete This Section)

YES

NO

Do you have, or have access to a HF SSB transceiver capable of being modified to
operate on all frequencies between 2-30 MHz?
Is your station capable of transmitting and receiving using an approved data waveform?
(Such waveforms include MIL-STD 188-110A Serial PSK)

Do you have a computer with internet access?

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 communicaitons 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, reimbursment, insurance, or other benifits to volunteers. Volunteers
are free to seperate 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
exercises.
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.
YES

NO

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?
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?

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

Army MARS- Individual Application, December 2022

Applicant is:
NOT
ACCEPTED

Signature SMD / RD

PREVIOUS EDITION IS OBSOLETE.

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AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, OMB#0702-0140 is estimated to average 15 minutes
per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters
Services, at [email protected]. Respondents should be aware that
notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a
collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATOIN. RETURN
COMPLETED FORM TO [email protected]

PRIVACY ACT STATEMENT

AUTHORITY: AR 25-6
PRINCIPAL PURPOSE: To request consideration to join the Army Military Auxiliary Radio System (MARS) program.
The information requested on this form is for the purpose of establishing, renewing, or modifying MARS membership.
The form will be maintained as part of official Army MARS records. The information on this form may be made
available to personnel at HQ Army MARS, Army MARS volunteer leaders in the Regions and States, and US Military
and Federal Government agencies.
ROUTINE USE(S): To provide basic applicant information necessary to determine the applicant's eligibility to join
and support the MARS program and the MARS mission. Additional Routine Users can be found in system records
notice DMDC 02, at https://dpcld.defense.gov/Portals/49/Documents/Privacy/SORNs/OSDJS/DMDC-02-DoD.pdf?
ver=2019-12-09-111827-743
DISCLOSURE: The information requested on this form is voluntary. However, failure to provide the requested
information may result in disapproval of the application.
Penalty for presenting false claims or making false statements in connection with claims: fine of up to
$10,000 or imprisonment for up to five years of both.

INSTRUCTIONS
The instructions for completing the Application to Operate a MARS Station Form AM-1 should be closely followed to
ensure accurate data collection and to preclude over collection of information. Sections Purpose of Application,
Applicant Information, Applicant Qualifying Information, Station Qualifying Information, Membership Agreement and
Certification of this form should be completed.

Army MARS- Individual Application, December 2022

PREVIOUS EDITION IS OBSOLETE.

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