Monday, 06 Sep 2010
 
 
Aplication PDF Print E-mail
Written by Administrator   
Sunday, 23 May 2010 15:50
                                          LZFFA
                  BULGARIAN FLORA FAUNA AWARD           
                                             “Lets save Green Planet Earth ! “               
 
              LZFFA  Aplication  Form
 
The underwrite …………………………, with callsign ……………., demand :
 
O       The  “LZFFA BRONZE” Award and Sticker to have CONTACTED
         No. …….different   LZFF references .
O       The  “LZFFA  SILVER” Sticker to have CONTACTED  No. …….  
          different  LZFF references.
O       The  “LZFFA  GOLD “  Sticker to have  CONTACTED  No. …….
          different  LZFF references.
O       The   “LZFFA BRONZE “ Award  and Sticker to have ACTIVATED 
          No. ….. different   LZFF references.
O       The  “ LZFFA SILVER “ Sticker to have ACTIVATED  No. ….. different     
          LZFF references.
O       The  “ LZFFA GOLD “ Sticker to have  ACTIVATED  No. …… different   
          LZFF references.
O       The  “ LZFF  HONOUR  ROLL “ Certificate to have CONTACTED                            
          No. ……. different   LZFF references.
O       The  “ LZFF  HONOUR  ROLL “ Certificate to have ACTIVATED
          No. …. …different   LZFF references.
 
O        Hunter  ( SWL ) Report Form:
Nr.   Reference         CALL         Date     Time       Band    Mode   RST   QSO
                                                                   /UTC /     /MHz/                          with:
_____________________________________________________________________
1.        LZFF-
2.        LZFF-
3.        LZFF-
4.        LZFF-
5.        LZFF-
6.        LZFF
7.        LZFF-
8.        LZFF-
9.        LZFF-
10.    LZFF-
11.    LZFF-
12.    LZFF-
13.    LZFF-
14.    LZFF-
15.    LZFF-
16.    LZFF-
17.    LZFF-
18.    LZFF-
19.    LZFF-
20.    LZFF-
21.    LZFF-
22.    LZFF-
23.    LZFF-
24.    LZFF-
25.    LZFF-
_________________________________________________________________       
 
O      I ask Paper version of the Award.
O      I ask Electronoic version of the Award.
 
O      I enclose for the LZFF Award and LZFF BRONZ Sticker by
          mail: ……… ( Euro, USD, New IRC )
O      I enclose for the LZFF  SILVER Sticker by mail: ..(Euro,USD,New IRC)
O      I enclose for the LZFF GOLD Sticker by mail: …. (Euro,USD,New IRC)
O      I enclose for the LZFF HONOUR ROLL Certificate:..(E,USD,New IRC)
 
I ask you that the Award / Stikers / Certificate is sent to following address:
Mr, Mrs,Miss ……………………………………………..
Address ……………………………………………………
Zip Code, City, Prov ……………………………………...
Country ……………………………………………………
E-mail: ---------------------------
Mob.No. : ……………………

 

  

Date: ……/……./201….                     Signature: ………………………….