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?

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.