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| DEMANDE DE BASE /
APPLICATION |
| EXTENSION /
ENDORSEMENT |
| ** rayer la mention
inutile ci-dessus ** |
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| Nom / Name |
VIDAL |
|
Indicatif / Call |
| Prenom
/ First Name |
.JEAN-MARIE |
|
EA5HE |
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| Adresse
- Adress |
.C/BILBAO Nº8 PTA 4 |
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| Ville
- City |
VALENCIA |
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| Code
Postal - Zip Code |
CP.46009 |
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| Nbr |
Réf. DIFI |
NOM DE ILE /
ISLAND NAME |
DATE |
Mhz |
MODE |
INDICATIF / CALL |
QSL |
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| 02 |
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| 03 |
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| 04 |
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| 05 |
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| 06 |
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| 07 |
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| 08 |
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| 09 |
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| 10 |
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| 11 |
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| 12 |
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| 13 |
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| 14 |
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| 17 |
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| 18 |
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| 19 |
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| 20 |
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| 21 |
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| 22 |
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| 23 |
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| 24 |
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| 25 |
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| DATE
: |
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SIGNATURE |
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| envoyer à / send to DIFI MANAGER : |
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| F5XL Jean-Pierre TENDRON |
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| L'Arawak , 316
Allée des Pins |
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|
Domaine de St-Pierre de Tourtour |
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| 83690 TOURTOUR -
FRANCE |
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