YLISSB Renewal Applicaiton

YLISSB Renewal Application

Complete all of the fields. Required fields are bold. A contact phone number is required but it will not be published.

Your CallsignYLISSB System #
Team Member CallsignYLISSB System #

Previous call sign, if recenlty changed  

Your Full Name  

Mailing Address  
CityState/ProvinceZip/Postal Code

Country  

Current E-Mail Address  

Phone Number      Birthdate  

Anniversary      OM/XYL First Name   

Are You A Veteran?   Yes No   If Yes, Branch of Service  

How would you like to receive the VOICE REPORT: Printed and Mailed CD Mailed PDF Emailed

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