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:
Type of visit:
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: