NCVEC QUICK-FORM 605 APPLICATION FOR AMATEUR …

NCVEC QUICK-FORM 605 APPLICATION FORAMATEUR operator / primary station license SECTION 1 - TO BE COMPLETED BY APPLICANTPRINT LAST NAME SUFFIX (Jr., Sr.)FI RST NAMEINITIALSTATION CALL SIGN (IF ANY)MAILING ADDRESS (Number and Street or Box)SOCIAL SECURITY NUMBER (SSN) or (FRN) FCC FEDERALREGISTRATION NUMBERCITYSTATE CODE ZI P CODE (5 or 9 Numbers)E-MAIL ADDRESS (OPTIONAL)DAYTIME TELEPHONE NUMBER (Include Area Code) OPTIONAL FAX NUMBER (Include Area Code) OPTIONALENTITY NAME (IF CLUB, MILITARY RECREATION, RACES) I HEREBY APPLY FOR (Make an X in the appropriate box(es))EXAMINATIONfor a new license gran t CHANGEmy mailing address to above addressEXAMINATIONfo rupgra de of my license clas sCHANGEmy station call sign systematicallyCHANGE myname on my license to my new nam e Applicant s Initials: _____ Former Name: _____RENEWALof my license grant .I certif y th at: I waive any claim to the use of any particular frequency regardless of prior use by license or otherwise; All statements and at tachments are true, complete and correct to the best of my knowledge and belief and are made in good fa ith ; I am not a representative of a foreign government; I am not subject to a denial of Federal benefi ts pursuant to Section 5301of the

ncvec quick-form 605 application for amateur operator/primary station license section 1 - to be completed by applicant print last name suffix (jr., sr.) first name initial station call sign (if any)

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  Form, Applications, Station, Operator, Primary, License, Quick, Amateur, Ncvec, Ncvec quick form 605 application for amateur, Ncvec quick form 605 application for amateur operator, Primary station license

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