DOMANDA DI ADESIONE AL GRUPPO SIX ITALIA

   Da inviare per posta a:
   IW0BET ZANGARA GIOVANNI, P.O.BOX 36, 00100 ROMA CENTRO

   Il sottoscritto (Cognome Nome)__________________________________________
   Nato a __________________________________ il ________/________/_________
   Titolare del nominativo ______________________ Locator _________________
   Indirizzo postale: _____________________________________________________
   Cap ____________ Citta'_________________________________________________ 
   Tel. __________________  Cell. _____________________________
   Indirizzo Packet _________@___________ Cluster __________@______________
   E-mail ___________________@_____________________________________________
           Chiede di essere ammesso al gruppo Six Italia - Six Italy.
   Comunica di aver collegato, sulla gamma dei 50 MHz, i seguenti 40 paesi
   DXCC:

       DATA      ORA      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
   ___/___/___|___.___|___________|_________|__________|_______________21
   ___/___/___|___.___|___________|_________|__________|_______________22
   ___/___/___|___.___|___________|_________|__________|_______________23
   ___/___/___|___.___|___________|_________|__________|_______________24
   ___/___/___|___.___|___________|_________|__________|_______________25
   ___/___/___|___.___|___________|_________|__________|_______________26
   ___/___/___|___.___|___________|_________|__________|_______________27
   ___/___/___|___.___|___________|_________|__________|_______________28
   ___/___/___|___.___|___________|_________|__________|_______________29
   ___/___/___|___.___|___________|_________|__________|_______________30
   ___/___/___|___.___|___________|_________|__________|_______________31
   ___/___/___|___.___|___________|_________|__________|_______________32
   ___/___/___|___.___|___________|_________|__________|_______________33
   ___/___/___|___.___|___________|_________|__________|_______________34
   ___/___/___|___.___|___________|_________|__________|_______________35
   ___/___/___|___.___|___________|_________|__________|_______________36
   ___/___/___|___.___|___________|_________|__________|_______________37
   ___/___/___|___.___|___________|_________|__________|_______________38
   ___/___/___|___.___|___________|_________|__________|_______________39
   ___/___/___|___.___|___________|_________|__________|_______________40


   I 2 soci presentatori della mia candidatura a socio di Sixitalia sono:

   Call:____________ Nr. Socio: _____ Firma del Socio:____________________
   Call:____________ Nr. Socio: _____ Firma del Socio:____________________
   
   Per le richieste di adesione via email, ove fosse difficoltoso farsi
   firmare questo modulo dai soci presentatori bastera' indicare il loro
   call ed i rispettivi numeri di iscrizione al gruppo; sara' cura della
   segreteria contattare gli stessi per conferma dell'assenso. 


   Di utilizzare le seguenti attrezzature per i 6 metri:

   ________________________________________________________________________

   Per l'iscrizione allega:
   Fotocopia del versamento della quota A.R.I. per l'anno in corso; 
   Dichiara di aver preso visione dello Statuto, con particolare riguardo
   all'Art.5 e si impegna a rispettarlo in ogni sua parte.

   Data __________________             Firma ______________________________