Request For Preparation of a Certificate 2003

The New Zealand Association of Radio Transmitters Incorporated

Please complete the requirements below and send to:
The General Secretary NZART, P.O. Box 40 525 Upper Hutt.

Our printer cannot set up the printing task without receiving the full and complete details from you. The information entered below must be checked and verified by two persons.

PLEASE PRINT IN CAPITALS

1. Brief description of the need for the certificate:

________________________________________

2. Date the completed certificate is required by:

__________________________________________

3. Name and address of the person to whom the completed certificate is to be sent:

_________________________________________________________________________

4. The general type of certificate (ring one):

Certificate of Service | Certificate of Merit | Amateur of the Year
Young Amateur of the Year | Honorary Life Member | Other (give details):

_________________________________________________________________________

5. Text for the header line (ring or amend):

The New Zealand Association of Radio Transmitters Incorporated
The New Zealand Association of Radio Transmitters
Campbell Island Branch 00 Incorporated
Other (give the text required):

__________________________________________________________________________

6. Text for the Title Lines - THE LARGEST PRINT - (ring one):

Certificate of Service | Certificate of Merit | Amateur of the Year
Young Amateur of the Year | Branch Life Member | Other (give details):

___________________________________________________________________________

7. If the certificate is a dedicated one-off with a printed-on name:

Name of recipient (check spelling very carefully - please PRINT):

First name: _________________ Family Name: __________________

Callsign: __________

8. Is the certificate required in quantity with a blank "name line" to be filled in by you later? Y/N?__

If so, how many copies are required? ____________

9. The certificate text required (see examples below - ring or amend):

____________________________________________________________________________

____________________________________________________________________________

10. If the certificate is for a term of service:

Start date: __________________________ Finish date: ________________________

11. Day/Month/Year of presentation to appear on certificate? Y/N? ____

Day: ______Month: ____________ Year: _____

12. The badge/logo to appear (at both sides of the certificate) - ring as required:

Standard NZART diamond | AREC Diamond/scroll with Branch Callsign: ZL_____
Other badge/logo variations (give details):

_________________________________________

13. Signatories:

President NZART (on Left) Y/N? | Secretary NZART (on right) Y/N?
Others (give details - names, callsigns, titles):

_____________________________________

___________________________________________________________________________

14. Certificate to be presented with (ring one):

Plain white envelope | Presentation jacket | Glass frame

15. The above entry details are supplied by (your name & address):

___________________________________________________________________________

Signature: ___________________

16. The above entry details have also been CAREFULLY checked AGAIN by

(name & address):

___________________________________________________________________________

Signature: ___________________

17. Your phone, fax or e-mail address for follow-up enquiries about this certificate request:

___________________________________________________________________________

Notes:

1. This certificate request may require the consideration of the NZART President, Council, or the AREC National Director before preparation can commence. Please allow adequate time.
2. Certificates are usually supplied in landscape A4 size. Other sizes require an explanatory letter.
3. A draft copy of the final certificate text may be faxed to you for checking.
4. A glass frame is usually supplied from local resources at the point of presentation.

Samples of typical certificate texts (abbreviated to save space)