APPLICATION FORM FOR AMATEUR OPERATOR-New or Renewal.

FOR USE IN THE VEC PROGRAM ONLY.

Print your Last name. 2. Suffix SR, JR, I, II, III. 3. First name. 4. MI.
5. Mailing Address or PO Box. 6. City 7. State [2] 8. Zip Code
9. Area code Day telephone 10. Taxpayer, SSN or FRN 11. Call Sign 12. Class
13. Email address  
___ Change my address.

___ Renew my license, if less than 90 day remaining or,

___ Renew my license, HOLD my license, FCC rule 90 day hold requirement.

___ Duplicate License, Lost License.

-------------------------------------------------------------------------------------------------------------------------------------

Certification Statement:

  1. The applicant waives any claim to the use of any particular frequency or electromagnetic spectrum as

    2. Against the regulatory power of the U.S. because of the previous use of the same, whether by license or

    otherwise, and request an authorization in accordance with this application.

  2. The applicant certifies that all statements made in this application and in the exhibits, attachments, or

Documents Incorporated by reference are material, are part of this application, and are true, complete,

Correct, and made in Good faith.

3. Neither the applicant nor any member thereof is a foreign government or a representative thereof.

4. The applicant certifies that the construction of the station would NOT be an action which is likely to have a

Significant Environmental effect (see the Commission's Rules 47 CFR Sec. 1.301-1.319)

  1. The applicant certifies that they have READ and WILL COMPLY with Section 97.13(c) of the Commission

Rules. Regarding RADIO FREQUENCY (RF) RADIATION SAFETY and the amateur section of

OST/OET Bulletin Number 65.

__________________________________________ ______________________

Candidate Signature Date Signed

Enclose the following:

  1. This application.
  2. A photocopy of your license.
  3. Non Vanity $6.00.          Price valid until 12-31-2008.
  4. Vanity renewal $20.00. Price valid until 07-31-2008.
  5. Chek payable to: Sunnyvale VEC Amateur Radio Club.

Mail to: Sunnyvale VEC ARC

               PO Box 60307

              Sunnyvale, CA 94088-0307

DO NOT USE THIS FORM FOR DIRECT SUBMITTALTO THE FCC.

SUNNYVALE Form 605.