NCVEC Quick Form 605 Intake 
This E Quick Form 605 , will be used to populate the NCVEC Quick Form 605 which you will receive electronically for signature
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LAST NAME *
FIRST NAME *
M.I.
Suffix
Jr. , Sr. II Etc. 
AMATEUR RADIO CALL SIGN (IF LICENSED)   *
Type NOCALL if not licensed
MAILING ADDRESS (Number and Street or P.O. Box)   *
 CITY   *
  STATE CODE   *
 DAYTIME TELEPHONE NUMBER (Including Area Code)   *
  FCC REGISTRATION NUMBER (FRN)  *
Basic Qualification Question -- *Answer Required in Order to Process Your Application*    Has the Applicant or any party to this application, or any party directly or indirectly controlling the Applicant, ever been convicted  of a felony by any state or federal court? *
I HEREBY APPLY FOR [Make an X in the appropriate box(es)]:   *
Required
If you Selected CHANGE my name on my license to my new name on the previous question  Please provide your Former name  Last name , Suffix , First name , MI 
If you selected CHANGE my station call sign systematically Please Type Your Initials to Confirm
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