DX - Lighthouse (DX-LH)

Application Form

(Back to Award Rules)

The Amateur Radio Lighthouse Society (ARLHS) is the proud sponsor of the DX - Lighthouse Award. Your signature on this application form confirms your reading, understanding and abiding by the ARLHS General Rules and Awards Requirements for this award. The basic award will be issued for 25 contacts with endorsements for each group of 25 thereafter untill 100 countries are worked. For the ARLHS official list of lights and their ARLHS numbers, please see the "ARLHS Lighthouse Numbers" list.

No.
ARLHS
LH #
Call
Lighthouse Name
Date
Band
1
         
2
         
3
         
4
         
5
         
6
         
7
         
8
         
9
         
10
         
11
         
12
         
13
         
14
         
15
         
16
         
17
         
18
         
19
         
20
         
21
         
22
         
23
         
24
         
25
         

Name (printed) _______________________________________ Call Sign ______________

Address __________________________________________________________________

City ________________________________ State/Country _______________ Zip _______

E-mail ____________________________________ ARLHS Membership Number _______

Signature ____________________________________________ Date _________________

Please check appropriate area: ___ Basic Award (25 QSO's); ___ 1st Endorsement (25 QSO's); ___ 2nd Endorsement (25 QSO's)

Enclose fees for certificate (US $2.00 for members; $5.00 for non-members) or endorsements ($2.00 each for USA applicants; $3.00 for DX).

Mail to: Award Manager: John Burnette, KF4ZLO, 2816 Timber Hills Rd, Louisville, KY 40214