Remote Receiver Application

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

Use this form to apply for the coordination of a remotely located receiver 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: _____________________________________________________________
Please Return to:
Roland Newton, KC0IEA
Frequency Coordinator
Iowa Repeater Council, Inc.
PO Box 2222
Ames, Iowa, 50010-2222