STATE OF ISRAEL

MINISTRY OF COMMUNICATIONS

ENGINEERING DIVISION

PERSONAL QUESTIONNAIRE FOR APPLICANTS

FOR AMATEUR RADIO LICENCE

Family Name + Callsign _____________________________________________________

Previous Family Name (if changed) _____________________________________________

First Name(s) ______________________________________________________________

Place of birth __________________________ Date of birth __________________________

Present Address of Residence;

* Street ___________________________________________________________________

* City ____________________________________________________________________

* Country _________________________________________________________________

Occupation ________________________________________________________________

Present place of employment __________________________________________________

Passport No. ______________________ Country _________________________________

Date of arrival in Israel ______________________________________________________

Address in Israel ____________________________________________________________

City ______________________________________________________________________

Equipment you bring with you;

Make & model nos. of equipments ______________________________________________

Power output of equipment ___________________________________________________

Date ___________________________ Signature __________________________________

Form 594


ONLY US AMATEURS FILL IN THIS FORM

Dear OM,

Received your request and hereby my reply to you;

A personal questionnaire for applicants for Radio Amateur License has to accompany the request to the Ministry of Communications. Please send us the following documents ( * to be submitted ) and information questionnaire;

1.* Photo copy of your passport.

2.* Photo copy of your Amateur Radio license and which grade you hold.

3. Family Name

First name(s)

Place and date of birth

Your present permanent address

Occupation

Place of Employment

4. Possible date of arrival and duration of stay.

5. Address were you will be staying, and/or can be reached.

6. Which kind of equipment you intend to take with you, make & model number of transceiver. Power of equipment.

Send all of this to I.A.R.C. Post Office Box 17600 Tel Aviv, 61176 and the club will take care of it that you receive the license.


ALL OTHER NON CEPT. COUNTRIES FILL IN THIS FORM

Dear OM,

Received your request and hereby my reply to you;

A personal questionnaire for applicants for Radio Amateur License has to accompany the request to the Ministry of Communications. Please send us the following documents ( * to be submitted ) and information questionnaire;

1.* Photo copy of your passport.

2.* Photo copy of your Amateur Radio license and which grade you hold.

3. Family Name

First name(s)

Place and date of birth

Your present permanent address

Occupation

Place of Employment

4. Possible date of arrival and duration of stay.

5. Address were you will be staying, and/or can be reached.

6.* Enclose check of 20 U.S. dollars to cover cost of license, (pay to order of CASH).

7. Which kind of equipment you intend to take with you, make & model number of transceiver. Power of equipment.

Send all of this to I.A.R.C. Post Office Box 17600 Tel Aviv, 61176. and the club will take care of it that you receive the license.


Joseph Obstfeld 4X6KJ, Honorary President of I.A.R.C. Membership Services
Tel/Fax: ++ 972 3 534 6049 IARU Liaison Officer

E-mail: josepho@shani.net

Best 73's & Shalom

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Joseph Obstfeld 4X6KJ Honorary President of I.A.R.C.
Post Office Box 873 I.A.R.U. Liaison Officer
Kiriat Ono 55000 Israel Tel/Fax: ++ 972-3-534 6049
E-mail: josepho@shani.net Packet: 4x6kj@4z4aaa.isr.mdle

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