Form Order Custome Plaque DXPedition

CONFIRMATION*

Saya telah membaca, memahami dan menyetujui syarat dan ketentuan tersebut di atas

Your Name*

Give us your full name, please.

Your Callsign*

Give us your a valid Amateur Callsign, please.

Email*

WA Number*

Whatsapp number

Please select your membership in YB6_DXC*

Member ID YB6_DXCommunity*

Point Claim*

Alamat Lengkap Pengiriman*

Tulis alamat lengkap anda berikut RT/RW/Desa/Kecamatan

Kota / Kabupaten*

Provinsi*

Message

Phone

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