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The Amateur Radio Lighthouse Society (ARLHS) is the proud sponsor of the ARLHS Member 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 member contacts with endorsements for each group of 25 thereafter.
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No.
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Member's Call
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Member's Name
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Member's QTH
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Member's ARLHS #
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Date
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Band
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1
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2
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3
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4
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5
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6
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7
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8
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9
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10
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11
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12
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13
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14
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15
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16
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17
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18
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19
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20
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21
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22
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23
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24
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25
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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