Application for Basic Ham Licence

We will probably not store or disclose any information given in this form, but we may consult it when considering your application

Part I: Personal Details

Please enter you name as you wish it to appear on the Licence document.

Please enter your email address

Spatial location: No fixed abode England Abroad

Please unselect this box if you don't not want to receive any unsolicited email .

Please select the nearest ethnic group Goth Geek Nerd French Spod Foriegn Mettler Pagan Townie TotL member Televangelist Social worker (nice) Social worker (evil) All of the above

Why do you have a criminal record?

Are you, or have ever been a member of the communist party? Yes Maybe No comment

Part II: Reasons for application

Please state in 10 (ten) words or less, why you think you deserve a Ham Licence

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Word 9:	Word X:

Part III: Past ham experience

Please select the option that best reflects your previous Ham experience.

Part IV: References

Please enter the names and email addresses of the 2 referees, who will be contacted by email and asked to vouch for your suitability for the possession of Ham.

First Referee
Name: Email address:

Second Referee
Name: Email address: