APPLICATION
TO OPERATE AN AMATEUR RADIO STATION IN CANADA
(Please Print or Type)

Applicant's Name __________________________________________________________________

Address ___________________________________________________________
__________________________________________________________________

Amateur Radio Call Sign ____________________________________________________________

Arrival Date in Canada ___/___/___ Departure Date from Canada ___/____/______

Address in Canada _________________________________________________________________
_________________________________________________________________
_________________________________________________________________

I, the undersigned amateur radio licensee, request a permit for operation of an amateur radio station in Canada. I understand that if a permit is granted, my operation of an amateur radio station must be in accordance with Canadian rules and regulations and the terms and conditions of the amateur licence issued by my government

Enclosed are:

1. A copy of operator's licence.
2. A copy of station licence, if issued separately.

Date __________________________

Signature _____________________________________________