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)