Jacksonville Laurel Registration
FIRST_NAME *
First name as appears on your ID
MIDDLE_INITIAL
Middle Initial as appears on your ID
LAST_NAME *
Last name as appears on your ID
NAME_SUFFIX
Suffix (Sr, Jr, etc)
Address
STREET_ADDRESS *
CITY *
STATE *
ZIP_CODE *
Contact Information
This is important as it allows us to contact you if there are any errors and to correct them before your results are sent to the FCC, which would otherwise cause your application to be rejected
TELEPHONE
E_MAIL *
FCC Registration Number
If you have an Amateur or GMRS Licence, you can find it on your license or at http://wireless2.fcc.gov/UlsApp/UlsSearch/searchLicense.jsp

If you don't have an FRN, you can create one in CORES at https://apps.fcc.gov/cores/userLogin.do

Once there:
a) Register in CORES
b) Verify your email and then log in
c) Apply for an FRN

YOU MUST PROVIDE AN FRN PRIOR TO THE TEST
FRN *
FCC Registration Number
Current License
CALL_SIGN
Current AMATEUR RADIO Call Sign(if any)
LICENSE_CLASS
CURRENT CLASS(if any): (N)ovice, (T)echnician, (G)eneral, (A)dvanced, or (E)xtra
EXPIRATION_DATE
Expiration Date
MM
/
DD
/
YYYY
I want to get...
NEW_LICENSE
You don't have a license...yet
UPGRADE_LICENSE
You want to upgrade your license and enjoy more privileges
RENEW_LICENSE
Your license expires within 90 days and you want to renew it.
CHANGE_ADDRESS
The address above is different than the FCC database
CHANGE_NAME
You want to update your name in the FCC database
CHANGE_CALL
You want to change your call sign systematically
Basic Qualification Question
FELONY_CONVICTION *
Have you ever been convicted of a felony in any state or federal court?
Other Information
Test Date
Accommodation
Do you need any accommodations for the exam?
Clear selection
PREVIOUS_APPLICATION
Do you have any previous applications, such as Vanity or Upgrades that haven't been acted upon?
Clear selection
How did you find about this test?
Clear selection
Would you like local clubs to email you about upcoming meetings and events?
Clear selection
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy