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

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

Operator	Select SINGLE-OP MULTI-OP CHECKLOG	Band	ALL	Mode	MIXED	Power	Select HIGH LOW QRP
Station	Select FIXED MOBILE PORTABLE ROVER

Exchange Info:

	RST Sent	QTH 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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