Online QSL Form

Name:

Address:

City:

Country:

E-mail:

Year of Birth:

Gender: Male Female

Religion:

Languages spoken:

Programs I have listened to:

Location Antenna Receiver Frequency

Monitoring Location Coordinates (N/S):

Monitoring Location Coordinates (E/W):

Antenna:

Receiver:

Frequency/ Meterband:

Date Time of Incident Report

Date (UTC):

FROM: Time (UTC):

TO: Time (UTC):

Signal And INFO Status

Signal Strength:

Interference:

Noise:

Fading:

Overall Merit:

Language:

Program Quality & Interfering Station:

Verification

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Location Antenna Receiver Frequency

Date Time of Incident Report

Signal And INFO Status

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