Call Used: ____________    Operators: ______________________________________
Category code: ____________  ( SOm / MOm / SOF / MOF / HOM )
Station Location: __________________________________________________________
Rig(s): ________________________________  Antenna(s): ______________________
Highest Power: ______W      Exchanged info: ________________________________
 ____________________________________________________________________________
|                                   |                                        |
|   STATE/PROVINCE/COUNTRY TOTALS   |               QSO POINTS               |
|                                   |                                        |
|                                   |                                        |
|   40M  = _____                    |        40M =  ____  ____  ____         |
|                                   |                                        |
|   20M  = _____                    |        20M =  ____  ____  ____         |
|                                   |                                        |
|   15M  = _____                    |        15M =  ____  ____  ____         |
|                                   |                                        |
|   10M  = _____                    |        10M =  ____  ____  ____         |
|                                   |                                        |
|                                   |     TOTALS =  ____  ____  ____         |
|                                   |________________________________________|
|                                   |                                        |
|                                   |           LOCATION MULTIPLIERS         |
|                                   |                                        |
|  TOTAL = _____(All SPCs per band) | Museum Station   = x5 ___ Home = x1 ___|
|                                   | Field Station    = x3 ___              |
|___________________________________|________________________________________|
|                                                                            |
|                              BONUS POINTS                                  |
|           (State names that begin with the following letters)              |
|                 (One state per letter, no duplicates)                      |
|                                                                            |
|           O     L     D     E     N        D     A     Y     S             |
|                                                                            |
|          ___   ___   ___   100   ___      ___   ___   ___   ___            |
|                                                                            |
| TOTAL BONUS POINTS: Number of States above x 100 = ____________ pts        |
|____________________________________________________________________________|

SUBTOTAL SCORE =  __________ X  ______  X  _____  +  _______ =  _____________
                   QSO Pts       SPCs       Loc       Bonus      Final Score

Comments:

I have followed all competition rules and all regulations for amateur radio in
my country. My report is correct and true to the best of my knowledge. I agree
to be bound by the decisions of the Contest Manager.

Date _________  Signature _______________________________    Call __________

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