Radio Amateurs of/du Canada

RAC Field Organization

Report of a Silent Key by a RAC Official


Please PRINT using capital letters throughout.  Send to RAC Headquarters by E-mail or FAX as soon as possible.

Name of Deceased _____________________________________________ Call Sign ____________________

Address including postal code__________________________________________________________________


RAC Member?  Yes__   No __  Unknown __     RAC Position Held, if any:_______________________________

Date of Death _________________________________   Deceased's Age on Date of Death__________________

I confirm that I have personally verified this notice of death by: ( check one)

► direct contact with the family  

► seeing a newspaper obituary     (Attach copy)

other means    (Give details)_________________________________________________________________________

Your Name _______________________________________________ Call Sign _________________________

Your RAC Appointment______________________________________________ Date____________________

Signature __________________________________________________________________________________

FSD-256-R (7/99)