Awards Manager Ted T. Sarah-W8TTS
(Basic Activators Award Application Form)
1. State/Province_______Lake___________________Call_____________Date_______________LH Name____________________________________ARLHS LH#_________
2. State/Province_______Lake___________________Call_____________Date_______________LH Name____________________________________ARLHS LH#_________
3. State/Province_______Lake___________________Call_____________Date_______________LH Name____________________________________ARLHS LH#_________
4. State/Province_______Lake___________________Call_____________Date_______________LH Name____________________________________ARLHS LH#_________
5. State/Province_______Lake___________________Call_____________Date_______________LH Name____________________________________ARLHS LH#_________
6. State/Province_______Lake___________________Call_____________Date_______________LH Name____________________________________ARLHS LH#_________
7. State/Province_______Lake___________________Call_____________Date_______________LH Name____________________________________ARLHS LH#_________
8. State/Province_______Lake___________________Call_____________Date_______________LH Name____________________________________ARLHS LH#_________
9. State/Province_______Lake___________________Call_____________Date_______________LH Name____________________________________ARLHS LH#_________
10. State/Province_______Lake___________________Call_____________Date_______________LH Name____________________________________ARLHS LH#_________
Contact Awards Manager Via E-mail for future Endorsement information.
Name (printed) _______________________________________ Call Sign ______________ Address _______________________________________________________________________ City ________________________________ State/Country _______________ Zip _______ E-mail ____________________________________ Signature ______________________________________________ Date _________________ Mail to: Ted T. Sarah-W8TTS 239 Bermont Ave,Munroe Falls,OH 44262-1105 USA