Call Used ? GOTA Station Call ? 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 ---------- Maritime Newfoundland/Labrador Quebec Ontario Manitoba Saskatchewan Alberta British Columbia NWT/Yukon/Nunavut ---------- Outside US/Canada Club or Group Name (Class A, B or F only) ? Number of Participants ? Number of Transmitters in simultaneous operation ? Entry Class (check only one): A. Club or non-club group portable ? B. 1 or 2 person non-club group portable ? List calls of operators C. Mobile ? D. Home station commercial power ? E. Home station emergency power ? F. EOC Station ? Power Source (check all that apply): Generator Commercial mains Battery Solar Other (list) Power Multiplier (check only one): 5 Watts or less and Battery powered = 5 150 Watts or less = 2 Over 150 Watts = 1 Bonus Points claimed: Check each box as appropriate and include required proof of points with your submission. All bonus points will be verified at ARRL HQ and added to your score. 100% Emergency power ? Media Publicity ? Set-up in Public Place ? Information Booth ? NTS message to ARRL SM/SEC ? W1AW Field Day Message ? Formal NTS messages handled ? — No. Natural power QSOs completed ? Site Visit by invited elected official ? Site Visit by invited served agency official ? Youth participation ?Number of youth participants who completed at least 1 QSO: Total number of youth participants: Educational activity ? Note: Bonus points for satellite QSO, GOTA QSOs and web submission will be automatically determined from info entered elsewhere on this form. Band/Mode QSO Breakdown: ? CWDigitalPhone QSOs Pwr(W) QSOs Pwr(W) QSOs Pwr(W) 160m 80m 40m 20m 15m 10m 6m 2m 1.25 Other Satellite For GOTA Bonus, list names, calls and number of QSOs for each GOTA station operator: ? Check for GOTA coach extra credit ? CWDigitalPhone Name Call QSOs Pwr(W) QSOs Pwr(W) QSOs Pwr(W) 1 2 3 4 5 6 7 8 9 10 I/We have observed all competition rules as well as all regulations for amateur radio in my/our country. My/our report is correct and true to the best of my/our knowledge. I/We agree to be bound by the decisions of the ARRL Awards Committee. Submission of this form indicates my/our agreement with these statements. ? Name Call E-mail Address Mailing address: Comments/Additional Explanation: Are you submitting supporting documentation to the ARRL as part of your entry: Yes No If yes, check method of submission: E-mail to: fieldday[at]arrl[dot]org Mail to: Field Day, ARRL, 225 Main St., Newington, CT 06111 USA
Club or Group Name (Class A, B or F only) ? Number of Participants ? Number of Transmitters in simultaneous operation ? Entry Class (check only one): A. Club or non-club group portable ? B. 1 or 2 person non-club group portable ? List calls of operators C. Mobile ? D. Home station commercial power ? E. Home station emergency power ? F. EOC Station ? Power Source (check all that apply): Generator Commercial mains Battery Solar Other (list) Power Multiplier (check only one): 5 Watts or less and Battery powered = 5 150 Watts or less = 2 Over 150 Watts = 1 Bonus Points claimed: Check each box as appropriate and include required proof of points with your submission. All bonus points will be verified at ARRL HQ and added to your score. 100% Emergency power ? Media Publicity ? Set-up in Public Place ? Information Booth ? NTS message to ARRL SM/SEC ? W1AW Field Day Message ? Formal NTS messages handled ? — No. Natural power QSOs completed ? Site Visit by invited elected official ? Site Visit by invited served agency official ? Youth participation ?Number of youth participants who completed at least 1 QSO: Total number of youth participants: Educational activity ? Note: Bonus points for satellite QSO, GOTA QSOs and web submission will be automatically determined from info entered elsewhere on this form. Band/Mode QSO Breakdown: ? CWDigitalPhone QSOs Pwr(W) QSOs Pwr(W) QSOs Pwr(W) 160m 80m 40m 20m 15m 10m 6m 2m 1.25 Other Satellite For GOTA Bonus, list names, calls and number of QSOs for each GOTA station operator: ? Check for GOTA coach extra credit ? CWDigitalPhone Name Call QSOs Pwr(W) QSOs Pwr(W) QSOs Pwr(W) 1 2 3 4 5 6 7 8 9 10 I/We have observed all competition rules as well as all regulations for amateur radio in my/our country. My/our report is correct and true to the best of my/our knowledge. I/We agree to be bound by the decisions of the ARRL Awards Committee. Submission of this form indicates my/our agreement with these statements. ? Name Call E-mail Address Mailing address: Comments/Additional Explanation: Are you submitting supporting documentation to the ARRL as part of your entry: Yes No If yes, check method of submission: E-mail to: fieldday[at]arrl[dot]org Mail to: Field Day, ARRL, 225 Main St., Newington, CT 06111 USA
Number of Participants ? Number of Transmitters in simultaneous operation ? Entry Class (check only one): A. Club or non-club group portable ? B. 1 or 2 person non-club group portable ? List calls of operators C. Mobile ? D. Home station commercial power ? E. Home station emergency power ? F. EOC Station ? Power Source (check all that apply): Generator Commercial mains Battery Solar Other (list) Power Multiplier (check only one): 5 Watts or less and Battery powered = 5 150 Watts or less = 2 Over 150 Watts = 1 Bonus Points claimed: Check each box as appropriate and include required proof of points with your submission. All bonus points will be verified at ARRL HQ and added to your score. 100% Emergency power ? Media Publicity ? Set-up in Public Place ? Information Booth ? NTS message to ARRL SM/SEC ? W1AW Field Day Message ? Formal NTS messages handled ? — No. Natural power QSOs completed ? Site Visit by invited elected official ? Site Visit by invited served agency official ? Youth participation ?Number of youth participants who completed at least 1 QSO: Total number of youth participants: Educational activity ? Note: Bonus points for satellite QSO, GOTA QSOs and web submission will be automatically determined from info entered elsewhere on this form. Band/Mode QSO Breakdown: ? CWDigitalPhone QSOs Pwr(W) QSOs Pwr(W) QSOs Pwr(W) 160m 80m 40m 20m 15m 10m 6m 2m 1.25 Other Satellite For GOTA Bonus, list names, calls and number of QSOs for each GOTA station operator: ? Check for GOTA coach extra credit ? CWDigitalPhone Name Call QSOs Pwr(W) QSOs Pwr(W) QSOs Pwr(W) 1 2 3 4 5 6 7 8 9 10 I/We have observed all competition rules as well as all regulations for amateur radio in my/our country. My/our report is correct and true to the best of my/our knowledge. I/We agree to be bound by the decisions of the ARRL Awards Committee. Submission of this form indicates my/our agreement with these statements. ? Name Call E-mail Address Mailing address: Comments/Additional Explanation: Are you submitting supporting documentation to the ARRL as part of your entry: Yes No If yes, check method of submission: E-mail to: fieldday[at]arrl[dot]org Mail to: Field Day, ARRL, 225 Main St., Newington, CT 06111 USA
Entry Class (check only one):
Power Source (check all that apply): Generator Commercial mains Battery Solar Other (list) Power Multiplier (check only one): 5 Watts or less and Battery powered = 5 150 Watts or less = 2 Over 150 Watts = 1 Bonus Points claimed: Check each box as appropriate and include required proof of points with your submission. All bonus points will be verified at ARRL HQ and added to your score. 100% Emergency power ? Media Publicity ? Set-up in Public Place ? Information Booth ? NTS message to ARRL SM/SEC ? W1AW Field Day Message ? Formal NTS messages handled ? — No. Natural power QSOs completed ? Site Visit by invited elected official ? Site Visit by invited served agency official ? Youth participation ?Number of youth participants who completed at least 1 QSO: Total number of youth participants: Educational activity ? Note: Bonus points for satellite QSO, GOTA QSOs and web submission will be automatically determined from info entered elsewhere on this form. Band/Mode QSO Breakdown: ? CWDigitalPhone QSOs Pwr(W) QSOs Pwr(W) QSOs Pwr(W) 160m 80m 40m 20m 15m 10m 6m 2m 1.25 Other Satellite For GOTA Bonus, list names, calls and number of QSOs for each GOTA station operator: ? Check for GOTA coach extra credit ? CWDigitalPhone Name Call QSOs Pwr(W) QSOs Pwr(W) QSOs Pwr(W) 1 2 3 4 5 6 7 8 9 10 I/We have observed all competition rules as well as all regulations for amateur radio in my/our country. My/our report is correct and true to the best of my/our knowledge. I/We agree to be bound by the decisions of the ARRL Awards Committee. Submission of this form indicates my/our agreement with these statements. ? Name Call E-mail Address Mailing address: Comments/Additional Explanation: Are you submitting supporting documentation to the ARRL as part of your entry: Yes No If yes, check method of submission: E-mail to: fieldday[at]arrl[dot]org Mail to: Field Day, ARRL, 225 Main St., Newington, CT 06111 USA
Power Multiplier (check only one):
For GOTA Bonus, list names, calls and number of QSOs for each GOTA station operator: ? Check for GOTA coach extra credit ?
Name Call E-mail Address Mailing address: Comments/Additional Explanation: Are you submitting supporting documentation to the ARRL as part of your entry: Yes No If yes, check method of submission: E-mail to: fieldday[at]arrl[dot]org Mail to: Field Day, ARRL, 225 Main St., Newington, CT 06111 USA
Mailing address: Comments/Additional Explanation: Are you submitting supporting documentation to the ARRL as part of your entry: Yes No If yes, check method of submission: E-mail to: fieldday[at]arrl[dot]org Mail to: Field Day, ARRL, 225 Main St., Newington, CT 06111 USA
Comments/Additional Explanation: Are you submitting supporting documentation to the ARRL as part of your entry: Yes No If yes, check method of submission: E-mail to: fieldday[at]arrl[dot]org Mail to: Field Day, ARRL, 225 Main St., Newington, CT 06111 USA
Are you submitting supporting documentation to the ARRL as part of your entry: Yes No
