Examination Application
- ARRL/VEC Michinoku VE TEAM -

Thank you for your application to the FCC examination. According to the following steps,
I perform your examination registration.

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0) Security check
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Please type letters displayed by the next image.

Type:

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1) An examination hope day and examination place
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Date : ”mm/dd/yyyy”
Place : ”Sendai”,”Aomori” and so on

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2) Your name
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Last Name : "Sendai"
Suffix : "Jr.", "Sr." ...etc
Fiest Name : "Saburo"
Middle Initial : "A" , "C" ...etc

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3) FRN
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FRN : "0123456789"

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4) Address in Japan
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Please input your address of Japan if you live in Japan.


"Omachi 1-2-3, Sendai 984-0888, Japan"

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5) Address in U.S.A.
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"225 Main St., Newington, CT 06111"

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6) Contact information
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E-mail : "w2zz@arrl.net"
Phone : "022-123-4567"
Cell Phone : "090-1234-5678"

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7) The US license which you own
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Please input the US callsign which you own now. Input with "none" if you do not own it.

US Callsign : "WC9QTC"
Class :

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Please input the US callsign which already expired for the subject exemption, Input
with "none" if you do not own it.

US Callsign : "KA9QSL"
Class :

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8) Subject exemption
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CSCE, Element 2
CSCE, Element 3
CSCE, Element 4
Expired Technician issued BEFORE 03/21/1987, Element 3
Current Technician issued BEFORE 03/21/1987, Element 2 and 3
Current Technician issued on 03/21/1987 or LATER, Element 2
Current Technician with old expired General, Element 2 and 3
Current Technician with old expired Advanced, Element 2 and 3
Current Technician with old expired Extra, Element 2,3 and 4
Expired General, Element 3
Current General, Element 2 and 3
Expired Advanced, Element 3
Current Advanced, Element 2 and 3
Expired Extra, Element 3 and 4

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9) Examination subjects
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Element 2
Element 3
Element 4
Up Grade only

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10) Question
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11) Signature
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Date : "mm/dd/yyyy"
Signature : "Saburo Sendai"

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記入項目は以上です、お疲れ様でした。

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