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Worked All Continents Application

Please print your Name:                                                                                  Call:                                                   

Address:                                                                                                           Ten-Ten #:                                        

City:                                                                                          State or Country:                                                       

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Continent Call 10-10 # Name QTH Date
Africa ___________ ___________ _______________ ___________________________ __________
Asia ___________ ___________ _______________ ___________________________ __________
Europe ___________ ___________ _______________ ___________________________ __________
North America ___________ ___________ _______________ ___________________________ __________
Oceania ___________ ___________ _______________ ___________________________ __________
South America ___________ ___________ _______________ ___________________________ __________

Send To:
Kevin J Gilot - NZ1I
56 Cindy Lane
Mystic, CT 06355-1404
email: kevinemtid@tvcconnect.net

Received QSL Cards Fee Award # Certificate Sent
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