General             In consideration of the permission extended to me by the United States through its officers and
                          agents to engage in activities of the executors and the administrators, remise, release, and
                          forever discharge the government of the United states, its officers, agents and employees, acting
                          officially or otherwise, form any and all claims, demands, actions or cause of action, on account
Release             of all damage to property and personal injuries, or death, suffered by me directly or indirectly
                         resulting from my participation in the activities of the Military Affiliate Radio System. I certify
                         that I will abide by all the governing rules and regulations nowand herein after prescribed by the
                         Department of Defense for the Military Affiliate Radio System. (This release is not intended to 
                         apply and shall not be construed to apply to statutory rights of personnel in the military service,
Clause               nor to any other rights of individuals under policies of life insurance (E.G., NSLI) or other forms
                         of contracts with the United States.)

                         Signature:                                                                                       Date:
___________________________________________________________________________________________________

Station                  High Frequency, HF (2-30 MHz): Required for participation in Navy-Marine Corps MARS.
                             Frequencies:

Capabilities           Very High Frequency, VHF (30-300 MHz):
                              Frequencies:

                              Ultra High Frequency, UHF (300-3000 MHz):
                              Frequencies:
                              RF Amplifier       Phone Patch          Repeater
                              Emergency Power      Deployable    Slow Scan TV
________________________________________________________________________________________________________

Digital                 Type of Computer: (IBM Compatible)      (Apple)   (No Computer)
Capabilities         RTTY AMTOR Pactor G-TOR Clover Packet PSK31 MT63 MFSK16
                           Other:
_____________________________________________________________________________________________
MARS                                                                                         Yes No
                  Are you currently a member of Army or Air Force MARS?                       
                  Have you ever been a member of Army, Air Force or Navy-Marine Corps MARS?   
Participation           If yes, state when and where:
                            Service: Call Sign: Dates:

                             Signature:                                                                      Date:
___________________________________________________________________________________________
OFFICIAL USE ONLY                                                                                                                                              
        State Director: Approve  Disapproval  (see attached letter)  State Director Call: NNN0G

       Signature:                                                                        Date:
___________________________________________________________________
        Region Director: Approve:  Disapproval  (see attached letter)  Region Director Call: NNN0AS

       Signature:                                                                        Date:
___________________________________________________________________
         Assigned MARS Call: NNN0
         Date of Entry in Navy-Marine Corps MARS:
____________________________________________________________________________________________
                                                                                                                                                 NMC Form 2093/1