USA _Officials

	DISTRICT DIRECTOR OFFICE

 

 

                                                                                                      To          Gruppo Radio Italia

                                                                            ALFA TANGO

                                                                                                                         P.O.Box 140

                                                                                                                      14100 Asti - Italy

 

 

 

 

	AT

 

 

 

       Prefix                                Number assigned                                    first name of the operator

 

      QSL ADDRESS : Line  to  print  on  yearly  directory  :

 

 

 

 

 

     PRIVATE ADDRESS  not appears on directory - needed only to send letters or club material

 

 

 

 

 

I declare that the above new member has contacted more than 20 members of our Club

 

I have inspected and verified the original  QSLs received from members of other Divisions of our Club. I therefore recommand that the above friend be registered as a new member.

 

MEMBERSHIP TYPE ( Mark if BASIC or FULL or GENERAL )

MEMBERSHIP FEE PAID BY MEMBER     Basic  $ 10 - FULL  $ 20 - GENERAL  $ 30

The new member works as : ( mark : CB - OM - SWL - BCL )

 

DATE OF MEMBERSHIP
DAY	MONTH	YEAR

 

 

 

             I have seen valid QSLs of these confirmed countries  :

 

1	18	35
2	19	36
3	20	37
4	21	38
5	22	39
6	23	40
7	24	41
8	25	42
9	26	43
10	27	44
11	28	45
12	29	46
13	30	47
14	31	48
15	32	49
16	33	50
17	34	51

 

TOTAL No                                                        CLASS OF

     OF CONFIRMED COUNTRIES  :                                                  OPERATOR

 

  LANGUAGES SPOKEN     .....................................................................................................................

      EVEN IF NOT FLUENTLY

 

CLUB MATERIAL   ID-card.

..................................................................................................................................

ISSUED TO MEMBER                                                                 Mark if y HAND

                                                                                                                                                                 or by POST

.............................................................................................................................................................

MATERIAL TO SEND FROM ASTI H.Q. :

 

.............................................................................................................................................................

 

Date :                                                                                 sign of the District Director