Radio Operator Endorsement Application

HANG GLIDING FEDERATION OF AUSTRALIA
4C/60 Keilor Park Dr ,Keilor East Vic 3033 - Ph (03) 9336 7155 Fax (03) 9336 7177
Website: www.hgfa.asn.au Email: [email protected] ABN:15 276 389 269
Date Recv’d
Amount
Chq # / CC
Waiver
VHF RADIO OPERATORS ENDORSEMENT
APPLICATION
Computer
Reply Sent
EN-06_V20141218
NOTE:
Office Use Only
Please complete all details in BLOCK letters.
Surname:__________________________________GivenName:___________________________________________
HGFA Number:______________________
Membership Expiry Date: _____ / _____ / _____
Email Address: ____________________________________________________
Address:______________________________________________ City/Suburb:_______________________________
State: __________
P/code: _______________
PILOT DECLARATION
Contact Phone Number:_________________________
Please tick appropriate boxes
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I, (Pilot's Name)BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB certify that the information above is true and correct and
request the issue of an HGFA Radio Operators Endorsement.
Signed: BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
Instructor Declaration
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