4U1A Guest Operator Booking Form

4U1A Guest Operator Booking Form

Please complete the form below.
Call sign*
Full Name*

First nameSur name
Date of birth

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Country CodeArea CodePhone Number
E-mail*
Class of License
License from:

MonthDayYear
License Expire (if applicable):

MonthDayYear
Date on which you would like to operate from 4U1A
You should come for the Authorisation card during VIC working hours.
Arrival - Date/Time

DayMonthYearHourMinutesAM/PM Option
Departure - Date/Time

DayMonthYearHourMinutesAM/PM Option
I am interested in working:

CW / SSBRTTY50 MHzSatelliteVHF/UHFOther
Type of visit:

Visitor (Single operator)Contest operator
Name of the contest & category Please indicate the team leader - contact person (if applicable).
Your remarks:
I (name) with my signature, fully accept the 4U1A Station Rules.
Place*
Date*

DayMonthYear
Signature*
Enter the message as it's shown*
Should be Empty: