Frequency
Coordination
System
Association

MEMBERSHIP APPLICATION FORM
             

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__________________________________________________ hereby applies to become a member of FCSA.

(Please Print Name of Company)

Address:
City:   Province:  
Postal Code:  Phone No.:  Fax #:
E-Mail:

Type of Telecommunications Service Provider
           

Local Telephone

Hydro Utility

Long Distance Telephone

CATV

Cellular

Other (Specify)

PCS

Number of Operating Microwave Radio Stations:

Total Amount of Microwave License Fees paid to Industry Canada on April 1 of Current Year: $
 

Reason for Seeking Membership in FCSA:

   

________________________________________________________________________________________________

   

________________________________________________________________________________________________

  

________________________________________________________________________________________________

 

On behalf of Applicant: 

_______________________________________

   

(Signature)

Name:
Title: Date:
 
SPONSORSHIP (2 required)

As a current FCSA Member organization in good standing the above Application is Recommended by:
 
    Name:______________________________________   _______________________________________________

(Please Print)

(Signature)

       
Organization:________________________________ Date: ___________________________________________


Return To: 

General Manager & Secretary-Treasurer

Frequency Coordination System Association

1 Nicholas Street, Suite 700

 

Ottawa, Ontario

 

K1N 7B7

Tel#: (613) 241-3080 

Fax#: (613) 241-9632

  E-mail: amoreno.fcsa@sympatico.ca