The Title (the first) page of the application for the award CORA (Cities Of Russia Award)
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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NOTES:
1. Read the terms for awards CORA and WACORA carefully.
2. Fill in the application form. Mark the appropriate places for the award
you apply for.
3. Contacts in the Application form must be in the ascending order of CORA numbers.
The award manager address is: Arkady ERBAEV - RZ0SB, P.O.Box 1224, Irkutsk,
664033, Russia
* * *
Next pages of the Application form must contain the following:
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QSOs containg the contatcts with the following cities of Russia for CORA-_______ Callsign ____________ Page____ of_____ pages |
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