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Suffolk County RACES Data Collection Form

To be completed by the Town's Radio Officer Only

Township
Name
Call Sign
License Class
RACES ID Number
Title (if applicable)
Street Address
City
State
Zip Code
Area Code and Phone Number
Area Code and Cell Phone Number
Email Address
Fax
Loyalty Oath On File? (Y/N)
IS100 On File? (Y/N)
IS700 On File? (Y/N)
EOC Access? (Y/N)
Where you issued a Suffolk ID card in 2007? (Y/N)