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Your
Name: |
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Present license
class: |
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CSCE credit: |
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Call sign (if applicable): |
Which exam do you plan to take?
Check any or all that may apply
* |
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Element 2: |
(Tech written) |
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Element 3: |
(General written) |
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Element 4: |
(Amateur Extra written) |
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Address: |
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Address (cont): |
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City: |
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State: |
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Zip / Postal
Code: |
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Daytime
phone: |
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Evening phone: |
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Fax: |
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Email: |
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Session
date: |
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Comments: |
* Test element 2 = Unlicensed to
Tech. Element 3 = Tech to General upgrade. Element 3+4 =
Tech to Extra upgrade. Element
2+3+4 = Unlicensed to Extra. Element 4 = General or Advanced
to Extra upgrade.
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