Six Italy 
                         Membership Application


   Last name:__________________________ First name:______________________
   Middle initial:_____________________ Nickname:________________________
   Place of birth________________________  Date/birth: day___/mo___/yr___
   Call sign ______________________ Locator _____________________________
   Mailing sddress_______________________________________________________
   __________________________________ tel./fax___________________________
   Pachet  address _________@_____________ Cluster _________@____________
   e-mail __________________________@____________________________________

   In order to comply with membership requirements, I submit the following 
   20 contacts with 20 different DXCC countries in 50 MHz:

       DATE     TIME      CALL    Even. N. C.   LOC.         DXCC
   ______________________________________________________________________
   ___/___/___|___.___|___________|_________|__________|________________1
   ___/___/___|___.___|___________|_________|__________|________________2
   ___/___/___|___.___|___________|_________|__________|________________3
   ___/___/___|___.___|___________|_________|__________|________________4
   ___/___/___|___.___|___________|_________|__________|________________5
   ___/___/___|___.___|___________|_________|__________|________________6
   ___/___/___|___.___|___________|_________|__________|________________7
   ___/___/___|___.___|___________|_________|__________|________________8
   ___/___/___|___.___|___________|_________|__________|________________9
   ___/___/___|___.___|___________|_________|__________|_______________10
   ___/___/___|___.___|___________|_________|__________|_______________11
   ___/___/___|___.___|___________|_________|__________|_______________12
   ___/___/___|___.___|___________|_________|__________|_______________13
   ___/___/___|___.___|___________|_________|__________|_______________14
   ___/___/___|___.___|___________|_________|__________|_______________15
   ___/___/___|___.___|___________|_________|__________|_______________16
   ___/___/___|___.___|___________|_________|__________|_______________17
   ___/___/___|___.___|___________|_________|__________|_______________18
   ___/___/___|___.___|___________|_________|__________|_______________19
   ___/___/___|___.___|___________|_________|__________|_______________20

   and a QSO with a Six Italy member, completed after November 29, 1996:

       DATE     TIME      CALL     Nr. Club     LOC.         Note
   ______________________________________________________________________
   ___/___/___|___.___|___________|_________|__________|________________1
   
   My 6 meter equipment is:  
   ______________________________________________________________________

   I certify that I have read the Group's constitution, in particular
   Article 5, and confirm that I will abide by the constitution.
 

   Date __________________             Signature ________________________


   Please forward this application by mail with a SAE (self addressed
   envelope) and enough IRC (International Response Coupons) to cover
   postage to:

   IW0BET, Giovanni Zangara, P.O.Box 36, 00100 ROMA CENTRO, Italy.