Radio Amateurs of/du Canada

Field Organization 

Order Form for Official RAC Callsign/Name/Appointment Badge

Submit to your Section Manager

 

 

Name:_________________________________________     Callsign:___________________________

Please print legibly exactly as it should appear on the badge

 

Address:_______________________________________________________________________________________________________________________________________________________________

Address to which you want the badge sent

 

Telephone number: (Day) ___________________________   (Evening) __________________________

In case we have a problem filling your order

 

Appointment   (check ONE only) 

 

VP Field Services  (    )              Section Manager (   )              Assistant Section Manager  (   )             Section Emergency Coordinator (   )  District Emergency Coordinator (   )   Emergency Coordinator (   )    Official Emergency Station  (   )     Section Traffic Manager (  )       NTS Net Manager (   )      Official Relay Station (    )                 Bulletin Manager (   )                           Official Bulletin Station  (   ) 

 

Note 1: Official badge not available for Assistant Emergency Coordinator or other positions not shown.

Note 2: Use this form only to order Official Silver RAC Field Organization badges. Do not order Official Brass Director/Executive/Committee badges on this form.

Note 3: This is a special order item and cannot be returned or refunded. Ensure the information provided above is clearly printed and correct.

 

I attest that I will only wear this badge while I hold the above appointment and remain a member of RAC.

 

Signed _______________________________________________ Date__________________________

 

Amount Enclosed - $15.00 including taxes, payable to RAC.  Please send form with payment to your Section Manager (SM).

 

For Section Manager Use ONLY

 

I have checked the information provided above and all is in order; the applicant is a current RAC Section appointee and RAC member. I hereby authorize purchase of an official RAC call-sign badge as specified.

 

RAC Section ____________  SM Signature & Call Sign ____________________________________

 

Date ______________________ Comments: ____________________________________________

Section Manager Please route this order form through the VPFS

FSD-290-R   (5/06)