Sunnyvale VEC. Form for change of Address or License renewal. Please Print: 1. Last name. ______________________________ 2. Suffix SR, JR, I, II, III. (Circle) 3. First name. ______________________________ 4. MI. ____ 5. Mailing Address or PO Box. ______________________________
6. City (USA) ______________________________ 7. State  _____ 8. Zip Code or Zip+4 __________-_______
9. Day telephone (Area Code) for the VEC._________________________
10. Taxpayer ID, SSN or FRN ______________________________
11. Call Sign_____________ 12. Class Technician or Technician Plus or Advanced or Extra (Circle)
12. Email address for the VEC. ______________________________ ___ Change my address. Non Vanity ___ Renew my license, if less than 90 day remaining or, Non Vanity ___ Renew my license, HOLD until the 90 day FCC requirement. Non Vanity ___ Duplicate License, Lost License. Vanity or non Vanity Certification Statement: 1. The applicant waives any claim to the use of any particular frequency or electromagnetic spectrum as 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) 5. 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 photo copy of your drivers License. 3. A photocopy of your license or we will look it up on the FCC WEB. 4. $6.00, please make your check payable to Sunnyvale VEC Amateur Radio Club. Mail to: Sunnyvale VEC ARC, Inc. PO Box 60307 Sunnyvale, CA 94088-0307 DO NOT USE THIS FORM FOR Direct Submittal to the FCC. SUNNYVALE Form 605, Jan. 1, 2012.