Arrl Vec Form 605 C – Fill Out and Use This PDF

APPLICATION FOR AN AMATEUR CLUB, RACES

OR MILITARY RECREATION STATION LICENSE

BE SURE TO READ ALL INSTRUCTIONS ON THE REVERSE SIDE. PLEASE TYPE OR PRINT LEGIBLY!

SECTION 1 -- Application Purpose (Check all boxes that apply.)

❏ NEW License Grant – (Not applicable to RACES)				❏ RENEW VANITY Club License – (FCC Fee)
					FCC Regulatory Fee must be submitted with this form
❏ CHANGE Club Station Trustee				❏ RENEW Non-Vanity Club License – (no FCC Fee)
					(RACES station licenses cannot be renewed)
❏ CHANGE Club Mailing Address AND/OR CLUB NAME				❏ CANCEL Club License
SECTION 2 -- Trustee Information
LAST NAME		SUFFIX	FIRST NAME					MI	CALL SIGN
DAYTIME TELEPHONE NUMBER (include area code)			FAX NUMBER (include area code)				E-MAIL ADDRESS
SECTION 3 -- Club Information
CLUB NAME						CALL SIGN (If none, write new)
CLUB MAILING ADDRESS						CLUB FRN or EIN (If new or unknown leave blank)
CITY				STATE	ZIP CODE	E-MAIL ADDRESS
SECTION 4 --	Certification
We certify that:

•The information provided on this application is true and accurate, to the best of our knowledge;

•We are not representatives of a foreign government;

•We are a club as defined under the provisions of Section 97.5(b)(2) of FCC Rules (see reverse of this form)

•The construction of the station for which this application is being submitted will NOT be an action which is likely to have a significant environmental effect (See 47 CFR Sections 1.301 1.319 and Section 97.13(a));

•We have READ and WILL COMPLY with Section 97.13(c) of the Commission's Rules regarding RADIOFREQUENCY (RF) RADIATION SAFETY and the amateur service section of OST/OET Bulletin Number 65 (See ARRL website, http://www.arrl.org/news/rfsafety/ for details.);

•We waive any claim to the use of any particular frequency regardless of prior use or otherwise;

•The station to be licensed will be inaccessible to unauthorized persons.

ARRL/VEC Form 605-C Feb 2007

ARRL VEC FORM 605-C INSTRUCTIONS

Use this form to apply for a new CLUB STATION license or MILITARY RECREATION STATION LICENSE, or modify an

existing CLUB STATION license or MILITARY RECREATION STATION LICENSE, through the services of one of the three FCC-approved Club Station Call Sign Administrators (CSCSA’s). To be issued a CLUB STATION license, a club

must be composed of at least four persons, have a name, a document of organization and management, and a primary purpose devoted to amateur service activities; consistent with Section 97.5(b)(2) of the FCC Rules.

PLEASE NOTE: An amateur can only be the trustee of one valid club station. A trustee may continue to serve the clubs that they are currently trustee of but may not be designated the trustee of any additional clubs after February 13, 2011. A club station may not hold more than one valid vanity call sign.

Use a typewriter or print clearly in ink.

Complete all applicable fields on this form - telephone numbers, fax number and e-mail addresses are optional, but supplying this information is recommended.

For modifications and renewals, if available, attach a copy of the current station license.

The application must be signed in ink by two different individuals, and then sent by mail/courier (not faxed) to a CSCSA.

Vanity License Renewals require a FCC Regulatory Fee. Along with this form, submit a check made payable to ARRL VEC. Club licenses listed with Radio Service code “HV” in the FCC database ( http://wireless.fcc.gov/uls/ ) are Vanity Licenses

and must pay the mandatory FCC fee. License changes and non-vanity license renewals are free. ARRL cannot process applications for NEW Vanity Call Signs. View the current fee schedule at http://www.arrl.org/arrlvec/vanityfee.html .

SECTION 1 -- Application Purpose

Check all boxes that apply.

SECTION 2 -- Trustee Information

Fill in the proposed or new trustee's name and call sign information (optional: phone, fax and/or email information).

PLEASE NOTE: An amateur can only be the trustee of one valid club station. A trustee may continue to serve the clubs that they are currently trustee of but may not be designated the trustee of any additional clubs after February 13, 2011.

SECTION 3 -- Club Information

Fill in the name of the club, club station call sign (unless the application is for a new license) and the US Mail address to which the license will be mailed; optionally, include telephone, fax and e-mail information. If the club has already been issued a Federal Registration Number (FRN) in the CORES program, include FRN in the space provided. If the club has been issued an EIN (Employer Identification Number) by the Internal Revenue Service, enter that number in the space provided. If the club has not been issued either an FRN or an EIN, leave this space blank. DO NOT enter a personal Social Security Number, ATIN or FCC License ID number.

SECTION 4 -- Certification

The applicant and responsible party should read the certification (including the RADIOFREQUENCY (RF) RADIATION SAFETY certification) before signing the application document.

Club Station Licenses

This section must be signed by the club license trustee and by another responsible club official. The trustee must hold an FCC issued amateur license of any class except Novice. The responsible club official must be an officer of the club.

He or she MUST NOT be the same person as the club license trustee.

Military Recreation Station Licenses

The signature of the applicant for a military recreation station must be that of the official in charge of a station provided for the recreational use of amateur radio operators, under the military auspices of the Armed Forces of the United States. The applicant need not be an amateur radio operator. The signature of the responsible official for a military recreation license must be that of the official in charge of the United States Government premises where the military recreation station is located. The responsible official MUST NOT be the same as the applicant.

Return this form by mail or courier to any CSCSA of the three CSCSA’s (ARRL, W5YI, W4VEC), and/or direct any questions to: ARRL VEC, 225 Main St, Newington CT 06111; phone: (860)594-0300; e-mail: vec@arrl.org.

June 2011