NCVEC QUICK-FORM 605 APPLICATION AMATEUR …

NCVEC QUICK-FORM 605 APPLICATION AMATEUR operator / primary station license PRINT LAST NAME SUFFIX (Jr., Sr.) FIRST NAME CALL SIGN (IF ANY) MAILING ADDRESS (Number and Street or Box) FEDERAL REGISTRATION NUMBER (FRN) - IF NONE, THEN SOCIAL SECURITY NUMBER (SSN) CITY STATE CODE ZIP CODE (5 or 9 Numbers) DAYTIME TELEPHONE NUMBER (Include Area Code) E-MAIL ADDRESS (MANDATORY) Basic Qualification Question: Has the Applicant or any party to this APPLICATION , or any party directly or indirectly controlling the Applicant, ever been convicted of a felony by any state or federal court? I HEREBY APPLY FOR (Make an X in the appropriate box(es)): EXAMINATION for upgrade of my license class CHANGE my name on my license to my new name Former Name: (Last name) (Suffix) (First name) (MI) CHANGE my mailing address to above address CHANGE my station call sign systematically Applicant s Initials: To Confirm Exp.

ncvec quick-form 605 application amateur operator/primary station license . print last name suffix (jr., sr.) first name

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