OCHEART Member Application

Thanks for your interest in OCHEART.

We appreciate your willingness to volunteer to serve the hospitals and medical facilities within Orange County in times of emergency and disaster when the normal communication channels are disrupted.

Please complete the information below so we can begin to process your application to join our program.

Name*
First Last
Mobile Phone*
Your primary Email Address*
Your Amateur Radio Call Sign, if any
Your Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Which if any emergency volunteer groups (CERT, RACES, American Red Cross, etc.) are you currently a member?
Personal Skills and Experience relevant to OCHEART's functions
Why do you want to be a part of OCHEART?
Acceptance*
By checking the box below, I understand that OCHEART members can be called upon in emergency/disaster situations to assist at hospital and medical facilities within Orange County and provide emergency communications.

I also understand that at no time I am allowed to self-deploy outside of the OCHEART Operating Procedures which explain when and how Team members are activated.

I also understand that a full state and federal law enforcement background check may be required to become a member of OCHEART.
- I understand and agree to these terms
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