===== Form AP2 Electronic Application ======

[PLEASE PRINT or TYPE]                                       date:

 (日本人の方は、英文と漢字の両方を記入して下さい)

Which do you want to take in this session ? Mark(X) either
  ( )Exam     ( )Upgrade procedure 

EXAM DATE:    -   -   
EXAM SITE: TOKYO, JAPAN
NAME Last: 
    First: 

(漢字)   : 
氏    名 :
現住所   :(〒    −   )
都道府県 : 
市町村   : 
         : 
TEL      : 

US CALLSIGN:          (CLASS          )   ( )NONE

Social Security Number/ TIN(or A-TIN): 

Do you have the valid CSCE?  ( )Yes   ( )No
   DATE ISSUED:   -   -   
   Valid Elements:( )1A  ( )1B  ( )1C   ( )2   ( )3A  ( )3B  ( )4A  ( )4C
   Valid Elements:( )1   ( )2   ( )3    ( )4

FOR NoExam UPGRADES ONLY
  What class do you want to upgrade? 
         ( )Technician  ( )General  ( )Extra
  Please bring all the evidences(original license, current license or CSCE) 
and their copies.

FOR EXAMINEES ONLY
Which Element do you want to take at this session?
  ( )1   ( )2   ( )3    ( )4
 (5WPM   Tech   Gene    Extra)
* Please bring the copy of valid license and CSCE.

(Non American citizen only)
Original(JA) CALLSIGN: 
Mailing address in the US:

The actual operating plan in USA and their possessions.
DATE            : From               To        
OPERATING SITE  : 
PURPOSE TO VISIT: 
PASSPORT NR     : 
EVIDENCE:_______________________________________(if any)
［宣誓］
上記の期間に渡航し、運用することを目的に受験致します。
サイン：                        日付：
                                                                Form AP2
email to:	 ve-request@ne.nal.go.jp]

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