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GOLF-TANGO international Membership form Chris P.o.Box 90012 62340 GUINES FRANCE

Unit : _________ Date : ________________ N°/C : ___________________ Do not write anything here

User-friendliness, truth, fraternity and the DX are our first motivations. Come to join us in the Golf Tango group to appease your hobby in a complete quietude and transparency. Then, if the way of conceiving our fantastic passion allures you, we would be honoured to count to you among impassioned Dxmen/women who account our club all around the world! Fill this form carefully, and send it back as fast as possible to: Chris - Po.Box 90012 – 62340 GUINES - FRANCE with your payment for the first year of 20 €uros . This inscription includes: Call sign, ID cards, 30 world QSL, a Cederom with the directory and videos end photos of all GT events in the year, and the possibility to be on the GT mailing list. For a couple, same name, same address, add 5 €uros. One form by member.

NAME:_____________________________________________________ NICKNAME:__________________________________________________ PERSONAL ADDRESS :__________________________________________________________________________________ ___________________________________________________________________________________________________________

ADDRESS FOR THE DIRECTORY:____________________________________________________________ _______________________________________________  I allow the Golf-Tango Group to publish this address in the Directory YES  / NO 

Recommanded by : Date of Birth:_______________________________________________ Personal Phone Number:_____________________________________________ Mobile Phone Number:_______________________________________________ @-mail address : _______________________________________________  I allow the Golf Tango Group to publish my e-mail address in the Directory :YES  / NO 

Membership Date :______________________________________________ RTX COUNTY:_______________________________________________ Unit number asked : _____ - _____ - _____ - _____ - _____ - _____ -_____ DATE AND SIGNATURE (OBLIGATORY): (This membership form signature implies the respect of the Golf Tango internal rules)

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In accordance with the provisions of the Data-processing and Freedoms French Law of January 6, 1978, you have a right of access, of correction, modification and suppression of the data concerning yourself Copyright 2004, GT Group.