National Frequency Coordinators' Council
CHARTER MEMBERSHIP APPLICATION
COORDINATION ENTITY
Entity Name: ______________________________________________________
This Entity is: ___ an
Incorporated Corporation or Association
___ an Unincorporated Association or Council
___ an Amateur Radio Club (not included above)
___ an Individual
___ other - Describe: ____________________________________
Mailing Address:____________________________________________________
City: _____________________________________ State: _____ ZIP: _________
Web Site URL: http://________________________________________________
Geographic Service Area Description: ___________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
NOTE: Coordination entities
having service area boundaries
that are not
contiguous with state
or county lines, should use applicable postal
ZIP codes (preferred)
or major geographical features such as rivers,
mountain ranges, etc.,
to describe these boundaries.
Frequency Bands Coordinated: _________________________________________
__________________________________________________________________
__________________________________________________________________
Amateur Community Recognition
Status Determined By Following
Method:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Page 1 of 5
==================================================================
APPLICATION STATEMENT
The named coordination entity
hereby applies for Charter
Membership in
the National Frequency Coordinators
Council. It
is understood the NFCC
is intended to be an organization for the
betterment
ofAmateur Radio
frequency coordination and that it does
not seek to govern
the activities
of member entities. It is also
understood the NFCC
is in the early
stages of formation and that details such
as Coordinator
Certification
Requirements and Standards, and operating
fund requirements,
will be
formally considered in the future.
I hereby certify that I have the
authority to make this
Application for
NFCC Membership and that the information
supplied is
correct as of the
date submitted. I have included
all documentation
of our coordination
policies and procedures currently in force.
Signature: __________________________________________________________
Name: __________________________________________ Callsign: ___________
Title: ______________________________________________________________
Date: _____________________, 1998
Page 2 of 5
==================================================================
National Frequency Coordinators' Council
CHARTER MEMBERSHIP APPLICATION
COORDINATION ENTITY - OFFICERS
Entity Name:
__________________________________________________________________
If the Coordination Entity is a
formal organization, please
list the
current officers and their titles
(President/Chairman/Vice
Pres/ Vice
Chair/Secretary/Treasurer/Database
Mgr/etc). If
the coordination
entity is an individual or group of
individuals, use
this page or the
coordinator information page as
applicable. Use
multiple copies of
these pages as necessary. Please
submit updates
when changes occur.
Name: __________________________ Title: __________________ Exp: ______
Mailing Address: ____________________________________________________
City: _____________________________________ State: ____ ZIP: __________
(Optional) Telephone - Home: ____-____-_________ Work: ____-____-_______
Email Address:
____________________________________ Callsign:
__________
Name: _____________________________ Title: ________________ Exp: ______
Mailing Address: _____________________________________________________
City: ______________________________________ State: ____ ZIP: __________
(Optional) Telephone - Home: ____-____-_________ Work: ____-____-_______
Email Address:
____________________________________ Callsign:
__________
Name: _____________________________ Title: ________________ Exp: ______
Mailing Address: _____________________________________________________
City: _____________________________________ State: ____ ZIP: __________
(Optional) Telephone - Home: ____-____-_________ Work: ____-____-_______
Email Address:
____________________________________ Callsign:
__________
Name: _____________________________ Title: ________________ Exp: ______
Mailing Address: _____________________________________________________
City: _____________________________________ State: ____ ZIP: __________
(Optional) Telephone - Home: ____-____-_________ Work: ____-____-_______
Email Address: ____________________________________ Callsign: __________
Page 3 of 5
==================================================================
National Frequency Coordinators' Council
CHARTER MEMBERSHIP APPLICATION
COORDINATION ENTITY - COORDINATORS
Entity Name: _______________________________________________________
If the Coordination Entity
functions with individual coordinators
or
coordination committees for
sub-jurisdictions within
their authority,
please list the individuals or committee
leaders below.
Use multiple
copies of this page as
necessary. Please submit
updates when changes
occur.
Coordination Responsibility Area / Band: _________________________________
__________________________________________________________________
Name: ____________________________ Title: ________________ Exp: ______
Mailing Address: ____________________________________________________
City: ______________________________________ State: ____ ZIP: _________
(Optional) Telephone - Home: ____-____-_________ Work: ____-____-_______
Email Address:
____________________________________ Callsign:
__________
Coordination Responsibility Area / Band: _________________________________
__________________________________________________________________
Name: ____________________________ Title: ________________ Exp: ______
Mailing Address: ____________________________________________________
City: _______________________________________ State: ____ ZIP: _________
(Optional) Telephone - Home: ____-____-_________ Work: ____-____-_______
Email Address:
____________________________________ Callsign:
__________
Coordination Responsibility Area / Band: _________________________________
__________________________________________________________________
Name: ____________________________ Title: _________________ Exp: ______
Mailing Address: _____________________________________________________
City: _______________________________________ State: ____ ZIP: _________
(Optional) Telephone - Home: ____-____-_________ Work: ____-____-_______
Email Address: ____________________________________ Callsign: __________
Page 4 of 5
==================================================================
National Frequency Coordinators Council
CHARTER MEMBERSHIP APPLICATION
COORDINATION ENTITY - NFCC REPRESENTATIVES
Entity Name: _______________________________________________________
The individuals named below are
to be considered the Primary
and Secondary
(if named) Representatives for this
coordination entity.
This Primary
Representative has full authority to
represent the entity
in all
instances when official NFCC business is
being conducted.
Included are
all properly noticed in-person meetings
and electronic
on-line
representation including official
ballots. The
Secondary Representative
has this authority to represent the entity
in the absence
of representation
from the Primary Representative.
(If the representative
has been listed on
an earlier page, only the name and
callsign need to be
listed below.)
PRIMARY REPRESENTATIVE
Name:
______________________________________ Callsign:
_____________
Mailing Address: ___________________________________________________
City: _____________________________________ State: ____ ZIP: _________
(Optional) Telephone - Home: ____-____-________ Work: ____-____-_______
Email Address:
_____________________________________
SECONDARY REPRESENTATIVE
Name:
_______________________________________ Callsign:
_____________
Mailing Address: ____________________________________________________
City: ______________________________________ State: ____ ZIP: _________
(Optional) Telephone - Home: ____-____-_________ Work: ____-____-_______
Email Address: _____________________________________
Page 5 of 5
==================================================================
Top of Page