1.	Band:	Check the appropriate Band for this request
2.	Output Freq:	TRANSMIT Frequency
3.	Input Freq:	RECEIVE Frequency – Leave BLANK if same as TRANSMIT Frequency
4.	City:	Name of nearest City or Town to the location of the System
5.	Alias:	Node Alias of this System if NETROM is supported. BLANK for APRS.
6.	Callsign:	Callsign including SSID – If SSID is “-0” OMIT
7.	Location:	Mountain Top, City, or other location Description
8.	Region:	Enter ONLY one of the following:  NW AZ, NC AZ, NE AZ, WC AZ, C AZ, EC AZ, SW AZ, SC AZ, SE AZ, PHX METRO, TUS METRO
9.	County:	County in which the System is located
10.	Baud:	Enter ONLY one of the following: 1200, 2400, 4800, 9600, 19200, 38400
11.	System Type:	Enter the closest term from the following: SWITCH, DIGI, BBS, NODE, DX CLUSTER, APRS, DIGITAL RPT, LINK
12.	Network Type:	Enter ONLY one of the following: NETROM, THENET, BPQ, TCP/IP, X1J, GATEWAY, PC/TNC, FLEXNET, KANODE, ROSE
13.	Software Type:	Enter ONLY one of the following: FBB, RLI, MSYS, AA4RE, AK1A, JNOS (If TNOS enter JNOS)
14.	IP Address:	Full numeric internet address for this frequency (Ex: 44.124.34.46)
15.	FQDN:	Fully Qualified Domain Name (Ex: heber.ampr.org)
16.	Latitude:	Format: DDMM.HH <DEGREES MINUTES . HUNDRETHS OF MINUTES> (EX: 3425.40)
17.	Longitude:	Format: DDDMM.HH <DEGREES MINUTES . HUNDRETHS OF MINUTES> (EX: 11034.64)
18.	Mountain Top:	Enter “Y” or “N” to indicate if the Site is a Mountain Top Site
19.	Freq 2:	Additional RF Port on this System
20.	Freq2 BAUD:	BAUD Rate of the Freq 2 Port
21.	Freq 3:	Additional RF Port on this System
22.	Freq3 BAUD:	BAUD Rate of the Freq 3 Port
23.	Freq 4:	Additional RF Port on this System
24.	Freq4 BAUD:	BAUD Rate of the Freq 4 Port
25.	Power Out:	Transmitter Output Power
26.	Emission:	Emission Type (Ex: 16F2D = 1200, 20F2D = 9600)
27.	Ant Type:	Enter OMNI, BEAM, CORNER, DIPOLE, Etc.
28.	Ant Gain:	Antenna Gain in dbi(Isotropic)  NOT  dbd(Dipole)
29.	Ant Bearing:	If directional, direction of main lobe(s) in DEGREES
30.	Ant Polarity:	Enter V, H, LC, RC
31.	Ant Height:	Antenna height above Ground Level in FEET
32.	Ant Elev:	Antenna height above Mean Sea Level in FEET
	SPONSOR INFORMATION
33.	Name:	Name or Initials of Sponsoring Organization.  Enter Owner’s Name if no Sponsor.
34.	Callsign:	Sponsor’s Callsign
35.	Address:	Sponsor’s Mailing Address
36.	City:	Sponsor’s City
37.	State:	Sponsor’s State
38.	Zip:	Sponsor’s ZIP Code
39.	Phone:	Sponsor’s Phone Number with Area Code
40.	E-Mail:	Sponsor’s E-Mail Address
	OWNER INFORMATION
41.	Name:	Owner’s Name
42.	Callsign:	Owner’s Callsign
43.	Address:	Owner’s Mailing Address
44.	City:	Owner’s City
45.	State:	Owner’s State
46.	Zip:	Owner’s ZIP Code
47.	Phone:	Owner’s Phone Number with Area Code
48.	E-Mail:	Owner’s E-Mail Address

CONTACT INFORMATION
49.	Name:	Name of the Point Of Contact for the System
50.	Callsign:	Contact’s Callsign
51.	Address:	Contact’s Mailing Address
52.	City:	Contact’s City
53.	State:	Contact’s State
54.	Zip:	Contact’s ZIP Code
55.	Phone:	Contact’s Phone Number with Area Code
56.	E-Mail:	Contact’s E-Mail Address
	SITE OWNER INFORMATION
57.	Site Owner:	Name of the Individual, Agency, or Company that owns the Site.
Limited to 50 Characters MAX.
	SUBMITTER INFORMATION
58.	Submitter:	Name of Person submitting this data
59.	Callsign:	Submitter’s Callsign
60.	Phone:	Submitter’s Phone
61.	E-Mail:	Submitter’s E-Mail Address

62.	Remarks:	Enter Information such as Major Links, Capabilities, Emergency Power, etc. APRS state type Station (WIDE5-5, etc.) Limited to 50 Characters MAX.
63.	Signature:	Sign the FORM
64.	Date:	Enter the Date Of Submission

COORDINATION  

	Coordination is for a specific frequency at a fixed geographical location.  The coordination approval is tied to the power output of the transmitter with the height above ground, site elevation and antenna gain taken into consideration.  ANY CHANGES TO THE ABOVE MIGHT REQUIRE COMPLETE RECOORDINATION.  Please check with the coordinator first. Only the Sponsor may change Licensee and Contact information.  These changes must be in writing.

The coordination procedures followed by the various coordinators have been established at the annual Repeater Owners meeting held each year during the ARCA Hamfest at Fort Tuthill.  The coordinators are NOT allowed to change procedures or policies.  The coordinators communicate at least weekly to discuss all coordination maters.
The Chairman of the Coordination Committee is appointed by ARCA.  His appointment is confirmed annually by the repeater owners at the Fort Tuthill meeting.  He serves at the pleasure of the Repeater Owners.

PROBLEMS
   If you are having problems using the Rick Text Format (.rtf) Coordination Form, you may list the Data Item Numbers (1 through 64) down a page and insert the information to the right of each number.

SUBMISSION  

	Submit the completed form to the ARCA PACKET Coordinator at packet@azfreqcoord.org