St. Kitts Application Page 1

Application For A Licence TO Operate An Amateur Radio Staton In The State Of St. Kitts-Nevis

Date

1. Full name of Applicant

2. Address

3. Age

4. Occupation

5. Evidence of Nationality
(Birth Certificate, photocopy of Passport, Drivers Licence, etc.)

6. Class of amateur licence held (attach photocopy)

7. Do you hold any other station licence? if yes, give call sign(s)

8. Exact location where it is proposed to install and operate a station in St. Kitts-Nevis
(Name of hotel, guest house, residence, etc.)

9. State amateur bands on which you plan to operate (10-15-20 etc.)

Maximum power input

10. Declaration of Applicant:

Name of Applicant (print)

Signature of Applicant