SSTV Der Pelikan Date Request Form
This is a request to use the SSTV Der Pelikan.  Approval is required by the FOSSOM Board.  
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Email *
Ship Number *
Ship City & State *
Skipper/Point Of Contact Last Name *
Skipper/Point Of Contact First Name *
Skipper/Point of Contact Phone Number *
Arrival Date *
MM
/
DD
/
YYYY
Arrival Time *
Time
:
Departure Date *
MM
/
DD
/
YYYY
Departure Time *
Time
:
Purpose of Cruise / Special Activities Planned *
Do you have a FOSSOM Skipper identified who will be aboard during your cruise? If yes, what is their name? If no, type "TBD" and we will assist you in scheduling a FOSSOM Skipper. *
I acknowledge this is only a request, and that FOSSOM will notify me when the request is approved. I acknowledge a FOSSOM Skipper must be aboard to use the boat. *
A copy of your responses will be emailed to the address you provided.
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