Page 1 of ________ pages
THE APPLICATION
for the award "CORA - _______"
Issue me the award "CORA-_________" for QSOs
at the band _____1.8 ____3.6 ____7 ____10 ____14 ____18 ____21
_____24 ____28 UHF______ MHz ____on any bands
with the mode ___CW ____Phone ____SSTV ____RTTY ____PSK31
___MIXED MODES
through satillite _____yes (mark here if yes)
with the power _____Watts _____Watts QRP _____Watts QRPp
My callsign, ________________________________________________________
Family (Last) name, name______________________________________________
Address:______________________________________________________________
______________________________________________________________________
E-mail: (All your personal data only for contacts
conserning the Award and could not be passed to any third party)
The payment for the award is done.
I have read and fully agree with the terms of award CORA issue
_______________________________ ____________________
Signature, Call Date
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The Declaration
We have checked all QSLs for the award and confirm its complete set
and confirm its full adequacy to the data in the Application.
_________________________ ______________ _______
Signature Call Date
_________________________ ______________ _______
Signature Call Date
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