Repeater/Beacon/Link etc. FORM 10
(email applications-fill in details; printed application-print doubled spaced)
(revised: 2001.06.01)

At the earliest opportunity, fill in the details and send to:
FMTAG, NZART Headquarters, PO Box 40-525, UPPER HUTT
Or email: fmtag@nzart.org.nz

Application date:
Originating Branch and Number:
Trustees (two required)
Trustee 1
Name:
Callsign:
NZART membership number (on Break-In wrapper):
Phone number:
Email address:
Trustee 2
Name:
Callsign:
NZART membership number (on Break-In wrapper):
Phone number:
Email address:

Permanent location, from InfoMap 260 series:
Name of site on InfoMap 260 series:
Site ground height on InfoMap 260 series:
Call Book listing (Y/N):
Desired name of station in Call Book:
Owner of site:
Owner of building housing station:

Type of station
Repeater (Y/N):				Digipeater (Y/N):
Beacon (Y/N):				If Beacon, Callsign:
Data repeater (Y/N):			ATV Repeater (Y/N):
Link repeater (Y/N):			STSP repeater (Y/N):
Other (give details):
Band for this station:
Antenna configuration:
Antenna polarisation:
Antenna gain (dB isotropic):
Antenna height above ground (m):
Direction(s) of maximum radiation (degrees true), or omni:
Feeder loss (dB):
Transmit Duplexer or Filter loss (dB):
Receive Duplexer or Filter loss (dB):
Make of Tx:					Model of Tx:
Make of Rx:					Model of Rx:
Transmitter output power (W):
ITU emission designator:
Main Power source Mains (Y/N):	Solar (Y/N):
Other (Y/N):				Backup power source (Y/N):

Copy of minutes of Branch meeting approving construction:

Comments and/or System diagram/description: