Radio Amateurs of

Radio Amateurs of/du Canada

Member Society of the International Amateur Radio Union

Note: All forms are available online for download and local printing at https://www.rac.ca/wp-content-uploads-files-ares-racfsforms/

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 Chief Community Services Officer. This form must be submitted for each and every change in an appointment,

including cancellations.

FSD-211-R (03/07)