Submitter's E-mail Address   ARRL/RAC Section: Select ---------- Connecticut Eastern Massachusetts Maine New Hampshire Rhode Island Vermont Western Massachusetts ---------- Eastern New York New York City-Long Island Northern New Jersey Northern New York Southern New Jersey Western New York ---------- Delaware Eastern Pennsylvania Maryland-DC Western Pennsylvania ---------- Alabama Georgia Kentucky North Carolina Northern Florida South Carolina Southern Florida West Central Florida Tennessee Virginia Puerto Rico Virgin Islands ---------- Arkansas Louisiana Mississippi New Mexico North Texas Oklahoma South Texas West Texas ---------- East Bay Los Angeles Orange Santa Barbara Santa Clara Valley San Diego San Francisco San Joaquin Valley Sacramento Valley Pacific ---------- Arizona Eastern Washington Idaho Montana Nevada Oregon Utah Western Washington Wyoming Alaska ---------- Michigan Ohio West Virginia ---------- Illinois Indiana Wisconsin ---------- Colorado Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota ---------- Nova Scotia New Brunswick Prince Edward Island Newfoundland/Labrador Quebec Ontario North Ontario South Ontario East Ontario Golden Horseshoe Manitoba Saskatchewan Alberta British Columbia Territories (YT,NT,NU) ---------- Outside US/Canada ---------- Aguascalientes Baja California Baja California Sur Campeche Chiapas Chihuahua Ciudad de Mexico Coahuila Colima Durango Estado de Mexico Guanajuato Guerrero Hidalgo Jalisco Michoacan Morelos Nayarit Nuevo Leon Oaxaca Puebla Queretaro Quintana Roo San Luis Potosi Sinaloa Sonora Tabasco Tamaulipas Tlaxcala Veracruz Yucatan Zacatecas

Call Used		Operator(s) Call(s)		Station Call

Operator	Select SINGLE-OP MULTI-OP CHECKLOG	Assisted	Select ASSISTED NON-ASSISTED	Band	10M	Mode	Select CW SSB MIXED	Power	Select HIGH LOW QRP
Station	Select FIXED MOBILE SCHOOL	Transmitter	Select ONE TWO	Overlay	Select NONE LIMITED-ANTENNAS

Exchange Info:

	RST Sent	QTH_or_Serial Sent
Variability	Same for each QSOVaries by QSO	Same for each QSOVaries by QSO
Info

Claimed Score     Club Name

Entrant's Full Name

Entrant's Address

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