Membership form

Mr. Coordinators:

I request to be a Cyber DX member of the GACW under his rules of ethic, sportmanship and solidarity. As a Cyber DX Member l will be free to use the GACW name and logo in my personal correspondence and/or QSL cards.

The Cyber DX is a free membership and I will receive my number and Award Member via Internet.

Call:
Last name:
First name:
Street:
Number:	Apt: Floor:
Postal Code:
City:
Province/State:
Country:
E-Mail:
Licence Category:

For security reasons we will send a CFM MSG

Cyber DX - Member - Only for DX Hams.

Sample