KL7AA

Anchorage Amateur Radio Club, Inc.

PO Box 1987

Anchorage, Alaska, 99510-1987

VOLUNTEER EXAMINER APPLICATION FORM

PLEASE TYPE, OR PRINT CLEARLY IN INK:

NAME: ____________________________________________________ CALL: ______________________

First Initial Last

MAILING ADDRESS (line 1) _______________________________________________________________

MAILING ADDRESS (line 2) _______________________________________________________________

CITY: _______________________________________ STATE: _______ ZIP:____________ +4 _________

WORK PHONE: ______________________ Extn: _______ HOME PHONE:_______________________

E-MAIL ADDRESS: ______________________________________________________________________

LICENSE CLASS:____________________________ EXPIRATION DATE:_________________________

HAS YOUR LICENSE EVER BEEN REVOKED OR SUSPENDED? _____________

ARE YOU CERTIFIED BY ANY OTHER VEC? (Give name) ______________________________________

CERTIFICATION

1. I agree to comply with the FCC rules, and all terms and conditions set forth in the VEC manual

2. I agree to comply with the examination procedures set forth by the Anchorage ARC VEC Board

3. I understand this accreditation is only valid in the State of Alaska

4. I am at least 18 years of age

5. I agree to indemnify and hold harmless the Anchorage Amateur Radio Club, Inc., and it’s agents for any action which it may

take on my VE accreditation application, or in the event that my accreditation is withdrawn at a later date, regardless of cause,

reasons, or circumstances.

6. I understand that violation of the FCC rules or willful non-compliance with the VEC will result in the loss of my VE accreditation,

and could result in loss of my Amateur Radio operator and station licenses.

By my signature below, I certify that I have read and understand these requirements, and that all statements I have made herein are true.

____________________________________________ _______________________

Signature of applicant Date

____________________________________________ _______________________

Approved by Date

To applicant: The status of any Anchorage ARC certified volunteer examiner may be checked at any time by going

to the Anchorage ARC website, and selecting the page that lists active volunteer examiners. New applicants should

expect to see their name listed within 10 days of filing their application. Anchorage ARC VEC does not issue

individual VE identification cards. To check status, go to: http://www.kl7aa.net/VEC/velist1.html