Provide all of the requested information on the form below, following the instructions on the reverse. Use a separate form for each badge order. (Photocopies of this blank form will be accepted).

NAME:___________________________________ CALL SIGN:_____________
(as it should appear on the badge -- PRINT LEGIBLY)

 

STREET ADDRESS:_______________________________________________

 

CITY__________________________________STATE_______ZIP__________

 

Daytime Phone:______________ Evening Phone:______________

 

E-mail address: _________________________

 

ARRL SECTION:____________________________

(only if you are a Section-Staff, Station, Emergency Communications or NTS Leadership appointee)

 

ARRL DIVISION:____________________________

(only if you are an Assistant Director, Advisory Committee Member, Division Legislative Action Chairman, Legislative Action Coordinator, Legislative Action Assistant, QSL Bureau Manager/Worker, Technical Advisor, Volunteer Counsel, Volunteer Consulting Engineer, Volunteer Examiner, ARRL Monitoring System appointee, WAS/VUCC Awards Manager, DXCC Card Checker, or Life Member)

 

APPOINTMENT:___________________________

(see table directly below for correct title)

[Life Members: enter "Life Member" or "Charter Life Member" as applicable]

AUTHORIZED COLOR:_____________________
(See table directly below)

 

CHOICE OF FASTENER:____________________________

 

AMOUNT ENCLOSED: $____________

 

Official American Radio Relay League Field Organization Call-Sign Badges: Eligibility and Background Colors

Section Staff Appointees -- GREEN
Assistant Section Manager, Affiliated Club Coordinator, Bulletin Manager, Official Observer Coordinator, Public Information Coordinator, Section Emergency Coordinator, Section Traffic Manager, State Government Liaison, Technical Coordinator

Station Appointees -- BLUE
Official Observer, Official Emergency Station, Official Relay Station, Technical Specialist, Official Bulletin Station, Public Information Officer, Local Government Liaison

Emergency Communications Appointees -- ORANGE
District Emergency Coordinator, Emergency Coordinator, Official Emergency Station, Assistant Section Emergency Coordinator, Assistant District Emergency Coordinator,  Assistant Emergency Coordinator

NTS Leadership Appointees -- LIGHT GREEN
NTS Area Staff, Net Manager

 

Division Appointees -- LIGHT BLUE

Assistant Director, Advisory Committee Appointee, Division Legislative Action Chairman

 

Other Appointees 

QSL Bureau Managers -- RUST
QSL Bureau Workers -- RUST

Legislative Action Coordinator -- RUST

Legislative Action Assistant -- RUST

Technical Advisors -- BROWN
Volunteer Counsels -- PURPLE
Volunteer Consulting Engineer -- PURPLE
Volunteer Examiners -- TAN
ARRL Monitoring System -- BURGUNDY
WAS/VUCC Awards Manager -- GRAY
DXCC Card Checker -- GRAY
Life Member, Charter Life Member -- YELLOW