Call Used: ____________    Operators: ______________________________________
Category code: ____________  ( SOTB / MOTB / SOB / MOB / SOF / MOF / HOM )
Station Location: __________________________________________________________
Rig(s): ________________________________  Antenna(s): ______________________
Highest Power: ______W      Exchanged info: ________________________________
 ____________________________________________________________________________
|                                   |                                        |
|   STATE/PROVINCE/COUNTRY TOTALS   |               QSO POINTS               |
|                                   |                                        |
|                                   |           40M   20M   15M   10M   TB   |
|   40M  = _____                    |           ____  ____  ____  ____  ____ |
|                                   |                                        |
|   20M  = _____                    |           ____  ____  ____  ____  ____ |
|                                   |                                        |
|   15M  = _____                    |           ____  ____  ____  ____  ____ |
|                                   |                                        |
|   10M  = _____                    |           ____  ____  ____  ____  ____ |
|                                   |                                        |
|                                   | TOTALS =  ____  ____  ____  ____  ____ |
|                                   |________________________________________|
|                                   |                                        |
|                                   |           LOCATION MULTIPLIERS         |
|                                   |                                        |
|  TOTAL = _____(All SPCs per band) |   Taco Bell = x5 ___ Border = x4 ___   |
|                                   |   Field     = x3 ___ Home   = x1 ___   |
|___________________________________|________________________________________|
|                                                                            |
|                              BONUS POINTS                                  |
|              Taco Bell stations are worth 10 pts each and                  |
|                may be worked more than once on all bands                   |
|____________________________________________________________________________|

SUBTOTAL SCORE =   __________ X  ______  X  _____   =  _____________
                    QSO Pts       SPCs       Loc        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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