Radio Amateurs of/du Canada

Member Society of the International Amateur Radio Union

Field Organization Report

Note:  All forms are available online for download and local printing at http://www.rac.ca/fieldorg/racfsforms.htm

Section__________________________________

Please note:     Initial Issuance   □                                          (check one)

                        Endorsement      □

                        Cancellation       □

                        Amendment        □

of the appointment as (position),________________________________________________________of

Name ________________________________________________Call Sign _______________

_____________________________________________________________________________

(Street address, city, province and postal code.  SEC/STM SM, please CONFIRM correctness of this information before submitting the form.)

_____________________________________________________________________________

Phone: ______________________________            E-mail: _______________________________

RAC member   Y     N   (Please circle)                       Membership # ____________  Expiry date: ____________

                                                                                                      (from RAC member card or TCA label)

To avoid embarrassment and delay, SEC/STM/SM please ensure that new appointees are current RAC members. 

Confirmed?   Yes ___   (If this is not checked off, the appointment cannot be confirmed by the VPFS.)

Area of responsibility, special duties, or reason for cancellation:

________________________________________________________________________

________________________________________________________________________

Date  _________________________________     Authorizing signature and call sign  ____________________________________

Return completed form to the Vice President Field Services.  This form must be submitted for each and every change in an appointment,

including cancellations.

FSD-211-R (03/07)