Submit a “Flight Plan”

CommsConnectUS -"Traveler's" Name *

First

Last

Code Name *

Every CommsConnectUS-"Traveler" Mission is code name protected. Should you require assistance, your Code Name will be means of identification. YOU choose your own Code Name.

Phone Number *

Phone number of the person traveling.

Emergency Contact and phone number *

Emergency contact and phone number of someone NOT traveling.

Date / Time of Intended Departure? *

Date

Time

Starting Location *

Destination *

Intended Route *

My trip will be: *

• One Way
• Round Trip
• I'm not sure yet.

Please choose all that apply *

• I have the CommsConnectUS-EMERGENCY ASSIST" Zello channel
• I am a Licensed Ham Operator

What is your CommsConnect-Zello Call Sign? *

What is your licensed Ham Call Sign (if applicable)?

CommsConnectUS, CommsConnectUS-"Partner Groups", and Assignees RELEASE FROM LIABILITY/HOLD HARMLESS: As a willing participant in the CommsConnectUS-"Traveler Program", I, (name below), (hereafter known as "CommsConnectUS-Traveler") understand and accept that this service is voluntarily accepted and administered. CommsConnectUS-Traveler understands that CommsConnectUS, its "Partner Groups", nor any assignees guarantees the safety of, nor accept responsibility for, CommsConnectUS-Traveler's safety during CommsConnectUS-Traveler service cycles. By submitting this "CommsConnectUS-Flight Plan" and signed Release, CommsConnectUS-Traveler releases all identified assignees from any liability and address to HOLD HARMLESS, all assignees, and hereby acknowledges and accepts the terms as outlined above. *

• I agree.

CommsConnectUS-"Traveler's" Signature *

First

Last

Entering your name serves as your electronic signature acknowledging agreement with the above RELEASE OF LIABILITY/HOLD HARMLESS.

Date

Time

What CommsConnectUS-"Partner Group" do you belong to? *

Comment

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