e1 ON-LINE APPLICATION FORM

    ALL questions should be completed, but the form will not send unless fields denoted* are completed plus the image verification (spam-resistant measure)
    On submission the form goes to committee members of the RSGB Emerging Technology Co-ordination Committee for vetting, and you will be contacted by one of them in due course.

    Section 1 - The Keeper

    Keeper First Name:    *   Surname:   *  Callsign:  *
    Address: 
    Town/County: 
    Postcode    Phone Code:  Phone Number: 
    E-mail address:  *
    Web address: 

    Section 2 - Repeater Service

    Repeater Callsign:    Type:   *
    Reason:  *
    Channel:  *
    TX (TV and non std):  MHz
    RX (TV and non std):  MHz   RX2:  MHz
    Channel Bandwidth (TX):  kHz  * (e.g. for 2 Metres analogue enter 12.5)
    Channel Bandwidth (RX):  kHz
    CTCSS: 

    Section 3 - Repeater Site

    Describe Site:  km    of (town) 
    NGR  *  or Irish Grid  (NB: Minimum 3+3 digits, for example TQ123987)
    WGS84: Latitude   Longitude 
    Use decimal format, for example 55.123456, -2.987654 (ensure West of Greenwich is "-")
    GPS accurate:  yes  no
    IARU Locator: 
    Site Name: 
    Site Address:  *
    Town/County:  *
    Site Postcode 
    Base of mast
    above sea level    		  Metres
    Note this will be equivalent to pavement/field level NOT roof level.
    Mast Owner: 
    Is site shared?: Yes     No
    If Yes, list: 
    Masts:   Number of masts used for the repeater.

    Section 4 - Equipment

    TX Antenna:  *  Gain:  dBd  *
    RX Antenna:   Gain:  dBd
    Height of TX ant:  Metres  * Note this is height above ground level, not sea level.
    Height of RX ant:  Metres   Note this is height above ground level, not sea level.
    Transmitter type:  include Make/Model
    Receiver type:  include Make/Model
    Power Levels: 
    TX Power out  Watts   all system Losses dB
    max.ERP  Watts  * (antenna gain was given above)
    Azimuth:   deg ETN else OMNI if not directional.
    Polarisation: Vertical     Horizontal
    Elevation:  degrees   Usually 0 but sometimes tilt applied.

    Section 5 - Closedown Details

    Access: Describe briefly access to the site. This should include how Closedown Ops will get to the site.
    *
    OnSite: Describe where repeater is located on site.
    *
    Disabled: How is repeater disabled?
    *
    Repower: State the person authorised to restore the power.
    *
    Closedown
    Operator 1:
    (Keeper)    		 
    Closedown Operator 1 must be the Keeper/Applicant
      STD Code:   Number:    Time: 
      STD Code:   Number:    Time: 
      STD Code:   Number:    Time: 
    Closedown
    Operator 2:    		 
      First Name:    Surname:   Callsign: 
      STD Code:   Number:    Time: 
      STD Code:   Number:    Time: 
      STD Code:   Number:    Time: 
    Closedown
    Operator 3:    		 
      First Name:    Surname:   Callsign: 
      STD Code:   Number:    Time: 
      STD Code:   Number:    Time: 
      STD Code:   Number:    Time: 
    Closedown
    Operator 4:    		 
      First Name:    Surname:   Callsign: 
      STD Code:   Number:    Time: 
      STD Code:   Number:    Time: 
      STD Code:   Number:    Time: 
    Closedown
    Operator 5:    		 
      First Name:    Surname:   Callsign: 
      STD Code:   Number:    Time: 
      STD Code:   Number:    Time: 
      STD Code:   Number:    Time: 
    Band:  Band to be used for remote closedown.
    Alternative: 
     Any alternative remote closedown method.

    Section 6 - Submission

    A coverage prediction map is prepared by the ETCC.
    You should attach any maps you may have already received or prepared yourself.
    Briefly describe what area you are trying to cover:

    coverage description:
    The following may be required to support your application.
    A facility to send up to 2 documents with this application (max.size 3MB) is at the foot of this form and can be used to send items required from the list below.

    1. Copy of Keeper's Licence Document (required to prove your eligibility)

      2.  copy attached   not attached

    2. Coverage Map (you may use ETCC map if one was prepared beforehand)

      3.  map attached   still to send

    3. Evidence of local area support may be requested for completely new applications.
      Your ETCC regional manager will discuss this requirement with you during the vetting stage.


    4. You must have permission to use the intended site and it is the Keeper's responsibility to ensure
      that there is adequate 3rd Party insurance liability cover.

      5.  accept   do not accept  *

    5. Information given in this form is subject to the provisions of the Data Protection Act 1998 and will be used
      in accordance with the appropriate entry attributed to the Radio Society of Great Britain and Ofcom.
      Please indicate your acceptance:

      6.  accept   do not accept  *

    Section 7 - Your say

    Short Message: 
    Note that any major issues should have been discussed with the ETCC prior to this stage.
    File 1 to upload:   (optional)
    File 2 to upload:   (optional)
    (max.file size 2MB total)
     
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