"Countdown on the air" SV Olympic program

NORTHERN GREECE CONTEST TEAM
Please accept my application and send the plaque to:
CALL SIGN:
TOTAL
Name:
QSOs:
Address:
 
Country:
No
CALL
DATE
TIME
BAND
MODE
REMARKS
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
TOTAL QSOs with SPECIAL GREEK STATIONS SXnA/xx from "Countdown on the air" program on this page:  
I declare that all credits pertaining to this award have obtained in accordance with the rules for the award as well as the rules and regulations for radio amateur in my country..
DATE: CALL: SIGNATURE:
Page .... from ....
Please don't write here .... Notes for Award manager
DATE: CLASSES: VERIFIED: