WAS Application Form

The author of this form is Eileen Sapko at esapko@arrl.org

 
 		      ARRL  WAS  APPLICATION FORM


Please print or type CLEARLY:  
NAME, CALLSIGN:   _______________________________________________
   	          (Print exactly as you want it on certificate)

List any ex-calls used on any cards  _____________________________

ADDRESS:__________________________________________________________

__________________________________________________________________
	(City)		             (State)	         (Zip)

Membership ID number (from QST label):____________________________

___ I have submitted an application via Logbook of the World 

------------------------  Check one: 
FUNDS ENCLOSED	       |  _____  Initial Application 
		       |  _____  Endorsement      
For QSL return postage |         ___ Original WAS # held is _______
Money/SASE	       |	  
		       |  I am applying for ONE of the following  	
$___________	       |  WAS Awards (each is numbered separately):	
		       |  ___ Basic Award (Mixed band and/or Modes) 
Return QSL's VIA:      |  ___ 50 MHz     ___ 144 MHz  ___ 432 MHz     
		       |  ___ 160 Meters ___ 222 MHz    
___  Registered	       |  ___ Satellite  ___ SSTV  
___  Certified         |      	 
     (US Only)         |  ___ I am applying for the following 
___  First Class mail  |  ENDORSEMENTS: (Check all that apply):
For Certificate $_____ |  ___ CW   ___ Novice  ___ QRP   ___ EME
For Endorsement $_____ |  Single Band (Circle one): 
For Certificate        |  10  12  15  17  20  30  40  80 (Meters) 
     and pin    $_____ |  
------------------------  ___ I am applying for the Phone Award (not
			      numbered):
			      ___  AM    ___ FM    ___ USB    ___ LSB
			      Other:  _______________________________	
			
			  ___ I am applying for the Digital Award (not 
			      numbered - except RTTY)  Circle one:
			      PSK31  AMTOR  PacTOR  CLOVER  G-TOR RTTY  
			      Other: _________________________________

  
I have read, understood and followed all the rules of WAS (MSD-264):  
          
_________________________________________	 _____________________
Applicant's Signature				         Date
				

* * * * * * * * *   HF AWARDS MANAGER VERIFICATION    * * * * * * * * *  

I have personally inspected the confirmations with all 50 states and 
verify that this application is correct and true. This application is 
for the following SPECIALTY awards or ENDORSEMENTS: ____________________
                                                    (Write NONE if none)

_________________________   ____________  H-____________    ____________
     Signature	  	    Callsign	    (Mgr code#)          Date


* * * * * * * * * * * *  DIRECTIONS TO APPLICANT   * * * * * * * * * * *  

1.  Read WAS Rules (MSD-264) carefully.
2.  Fill out this Application Form.
3.  Sort cards by state as listed on the Record Sheet and fill in Record 
    Sheet.
4.  Present application and cards to your ARRL HF Awards Manager for 
    verification. Applications from DX stations may be certified by the 
    Awards Manager of your IARU member-society.
5.  Send application to ARRL HQ with the appropriate fee(s):
    $10 for each WAS certificate, or $15 for each WAS certificate and pin
    (the fee includes any endorsements on the same application) $7.50 per 
    endorsement application (if applying for multiple endorsements on the 
    SAME application, with the SAME 50 QSL cards, the fee remains $7.50) 
    Example: 10 Meters and Novice. Send cards ONLY if there is no local 
    HF Awards Manager to verify your application. 
6.  If mailing cards, enclose sufficient postage for return of your 
    cards. Mail to: ARRL WAS Award, 225 Main Street, Newington, CT 06111.


September 2006


												                      MSD-217(7/01)