MISSOURI
REPEATER COUNCIL, Inc.
Member, Mid-America Coordination Council,
Inc.
APPLICATION FOR FREQUENCY COORDINATION
(MRC FORM 004 02/01/08)
Operator/Club Name:
__________________________________________________________________
Contact Person:
_______________________________________________________ Call: ___________
Address:
____________________________________________________________________________
Email Address:
______________________________________________________________________
City:
Telephone: Home:
( ) ______________________
Work: ( ) ______________________
Repeater Callsign:
___________________ Coordination Trustee Callsign:
___________________
Proposed Band of Operation: _______ Proposed
Frequency: Input:__________
Output:________
Leave Blank Leave Blank
Access:
COS VOX CTCSS __________ DTMF (circle one)
Autopatch: YES
NO Autopatch
Access: OPEN CLOSED
(circle one)
Area Served (City) ______________________________________________
For repeater directory
Coordinates of Proposed Site: Latitude _____ Deg _____ Min _____
Sec
Longitude _____ Deg _____ Min
_____ Sec
Site Address:
________________________________________________________________________
(Example: 120 So. Main or 1« miles West of Hiway 92, on County Rd "J")
City:
____________________________________County: ___________________________________
Effective Radiated Power (ERP): _______ Ground Elevation: ________ HAAT
_______
Each Remote Receive Site which you propose must
be coordinated.
Please include additional copies of this form
for EACH remote receive site in your system.
Modifications Planned:
_____________________________________________________
I have read the "Frequency Coordination
Guidelines" and by signing below, agree to abide by these guidelines or I
understand that I may lose my coordination.
SIGNED: ________________________________________
DATE: _______________
Note! The application process takes 30 days or
more in some cases. Please do not
inquire about the status of your application until the normal 30-day processing
time has elapsed. Please return signed application to:
Bryon Jeffers,
KØBSJ Jeff Young, KB3HF
k0bsj_@missourirepeater.org kb3hf_@missourirepeater.org
(816) 377-7093 (636)
928-7348