PREREGISTRATION FORM

FCC Amateur Radio Operator License Examination
by the W5YI VEC Kyushu VE Team

PLEASE TYPE

A 1 Last Name :
A 2 First Name :
A 3 Current address :
A 4 E-mail :
A 5 Phone :
B 6
B 7 Name :
B 8 Address :
B 9 Zip code :
C 10 Current US CallSign :
C 11 Class :
D 12 Mailing Address in U.S.A. :
E 13 Do you have any valid CSCE?
No
Yes Element : /Date issued (mm/dd/yy)
    
E 14 Which element(s) do you wish
to take at this session?
1:(Technician)
2:(General)
3:(Extra)
F 15 (Non American citizen only)
Your home Call Sign :
G 16 Date of birth :
Month / Day / Year :

It was tired with labor. Please push a "transmitting" button and transmit the contents.


※If an input finishes, please copy and place for a sense.