NCVEC QUICK-FORM 605 APPLICATION AMATEUR …

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? YES NO 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)CITY STATE CODE ZIP CODE (5 or 9 Numbers) DAYTIME TELEPHONE NUMBER (Include Area Code) E-MAIL ADDRESS (MANDATORY TO RECEIVE LICENSE NOTIFICATION EMAIL FROM FCC)I HEREBY APPLY FOR (Make an X in the appropriate box(es)): EXAMINATION for upgrade of my license class CHANGE m y 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.

amateur operator/primary station license . print m.i.last name suffix (jr., station call sign (if any)sr.) first name . mailing address (number and street or p.o. box) federal registration number (frn) city . state code zip code (5 or 9 numbers) daytime telephone number (include area code)

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  Operator, Amateur, Amateur operator

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