QUESTIONAIRE FOR ARRL 500-kHz EXPERIMENTAL LICENSE


CONTACT INFORMATION:

Amateur Callsign:
Name:
Mailing Address:
Telephone
    Day:
    Evening:
E-mail:



BACKGROUND INFORMATION

Radio/Electronics
    Education
    Employment

Amateur Radio
    License class:
    Year first licensed:
    Memberships:
    Activities:

Experimental Operation
    Lowfer (part 15) or Experimental (part 5, including 600MRG)
    Callsign:
    Describe station:
    Activities:


PROPOSED 500-kHz EXPERIMENTAL STATION

Location
    Physical address:
    Lattitude:
    Longitude:
    Altitude (MSL):
    Distance to nearest airport:
    Distance to nearest hospital:

Equipment
    Transmitter:
        Power
    Receiver:
    Transmitting Antenna:
        Description (sufficient to draw a picture)
        Dimensions:
    Height of antenna compared to surroundings:

Preparation Required
    What has to be done to get on the air:
    How long will it take (weeks):

Operation Capabilities
    Beacon operation?
    QSO operation?
       
Modulation Capabilities
    What modulations will you be able to use?
    CW
    QRSS
    PSK-31
    AMTOR
    Other

Portable Capabilities
    Receiving?
    Transmitting?
    

OTHER NOTES