Michigan DX Associations
Great Lakes Lighthouse/Lightship Award (GLLA)
Endorsement Application Form

The Great Lakes are Michigan, Superior, Huron, Ontario and Erie

The Great Lakes States/Province are Michigan, Minnesota, Wisconsin,
Illinois, Ohio, Indiana, Pennsylvania, New York, and the Canadian Province of Ontario

After earning the Basic Contact Award, work additional lighthouses/lightships on the
Great Lakes in groups of five (5) for each endorsement.

*Don't forget the copies of the QSL cards.*


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#_________

Your signature on this application form confirms your reading, understanding, and abiding by
the Awards Requirement for this award, and abiding by good amateur practices. The basic award
endorsement will be issued for each additional five (5) contacts of Great Lakes lighthouses/
lightships, after the basic award is earned.  Please use the list of lights from the ARLHS to 
help me track your awards.  The fees for endorsement are as follows:
   1.    For each endorsement applied for at the same time as an award $1.00(US), U.S. and DX.
   2.a.) For the US, for the first endorsement NOT applied for at the same time as an award
         $2.00(US), and $1.00(US) for each additional endorsement sent for at the same time.
   2.b.) For DX, for the first endorsement NOT applied for at the same time as an award
         $3.00(US), and $1.00(US) for each additional endorsement sent for at the same time. 




Name (printed) _______________________________________ Call Sign ______________

Address _______________________________________________________________________

City ________________________________ State/Country _______________ Zip _______

E-mail ____________________________________                                    

Signature ______________________________________________ Date _________________
Make checks payable to, and mail to: Ted T. Sarah-W8TTS 239 Bermont Ave,Munroe Falls,OH 44262-1105 USA