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Repeater Application Form e1-online
Please note that the recommended method for submitting applications is by using the e1 form which is in the widely used Microsoft Excel^tm 97 format.
This on-line form is primarily intended for applicants with disability or who may not be able to manipulate or have access to the Excel^tm software used in the e1.
All questions should be completed, but the form will not send unless fields denoted * and the verification image are completed.
On submission the form goes to the Proposals Manager who will pass the application in Excel^tm format to the appropriate ETCC Regional or Specialist Manager for vetting, and who will contact you in due course.

Section 1 - The Keeper

Keeper Title:		First Name: * Surname: * Callsign: *
Address:
Town/County:
Postcode		Telephone:
E-mail address:		*
Web address:
Region:

Section 2 - Repeater Service

Repeater Callsign:		Type: *
Reason:		*
Channel:		*
TX (TV and non std):		MHz
RX (TV and non std):		MHz RX2: MHz
CTCSS:

Section 3 - Repeater Site and Equipment

Describe Site:

km of (town)

NGR

* or Irish Grid

WGS84:

Latitude Longitude

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.

TX Antenna:

* Gain: dBd *

RX Antenna:

Gain: dBd

Mast Owner:

Is site shared?:

Yes No

If Yes, list:

IARU Locator:

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:

Receiver type:

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.

Masts:

Number of masts used for the repeater.

Section 4 - Closedown Details

Access:

Describe briefly access to the site.
*

OnSite:

Describe where repeater is located on site.
*

Disabled:

How is repeater disabled?
*

Repower:

Explain how only amateurs can repower the repeater.
*

Closedown
Operator 1:
(Keeper)

Closedown Operator 1 must be the Keeper/Applicant Number: Time: Number: Time: Number: Time:

Closedown
Operator 2:

First Name: Surname: Callsign: Number: Time: Number: Time: Number: Time:

Closedown
Operator 3:

First Name: Surname: Callsign: Number: Time: Number: Time: Number: Time:

Closedown
Operator 4:

First Name: Surname: Callsign: Number: Time: Number: Time: Number: Time:

Band:

Band to be used for remote closedown.

Alternative:

Any alternative remote closedown method.

Section 5 - Coverage

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:

Section 6 - Submission

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.

Copy of Keeper's Licence Document

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

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.

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.

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:

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 3MB total)

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