Proof of Amateur Activity
Proof of Amateur Activity
Proof of Amateur Activity
Date: ___________________________
ACTIVITY DATES
FROM TO NO. OF CONTACTS
TYPE:
A. DX ___________________ _________________ ____________________________
B. TECHNICAL ___________________ _________________ ___________________________
C. EMERGENCY COMMUNICATION EMERGENCY SITUATION
___________________ _________________ ___________________________
___________________ _________________ ___________________________
___________________ _________________ ___________________________
D. CLUB MEMBERSHIP
________________________________________________
( Enclose your club certification )
_________________________________
Applicant’s Signature
ENDORSEMENT
_________________________________
Signature over printed Name
NOTE: This form to be filled in duplicate to be submitted with your applicant for renewal of Amateur Radio License.
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