Address ____________________________________________________________________________
City __________________________________ State / Province / Country _____________________________
Postal Code __________________ E-mail _______________________________________
[A} Total number of all contacts in this log (1 pt each) = _______ X 1 pt = ________
[B} Plus total Member contacts in this log = ___________ X 2 pts = ________
[C} Plus total Lights contacted in this log = ____________ X 3 pts = ________
[D} Total points for this log (sum of A, B, and C) = ______________
Was the operation reported in this log done from a lighthouse that you activated for this event? If so, please give its ARLHS name(s) and number(s) here: _____________________________________________________________________________________
[E} If you answered “yes” to the question above and you activated a lighthouse or lightship under the ARLHS rules for activation, multiply your score from line D above X 2 and enter your Total Score for this log here ______
[F} Add together the Total Scores from all your logs.. Your FINAL EVENT SCORE = ________________
I am applying for the certificates, endorsements to certificates, and prizes listed below.. I verify that this log is true and correct to the best of my knowledge, and I have operated in accordance with ARLHS rules and the laws of my country. I understand that logs will not be returned and that they will be retained on file for only 30 days following the deadline for log submissions.
I am enclosing the amounts indicated.
(Note: Do not use this form to apply for ARLHS Awards.
See the web site Awards Page (Page 9) for appropriate awards application forms.)
Signed: ________________________________________________________________
_______ I qualify for purchase of a collectible
mini-lighthouse and have enclosed the required shipping & handling fee.
NOTE: Shipping/handling fee is NOT required for mini-lights awarded as prizes.
No choice of light is available. Selection is random.
_______ Certificate for working club station W7QF ($2.00 + SASE with US postage 97¢)
_______ Certificate for working either 50 lights or 100 members ($2.00 + SASE with USA postage 97¢) - make check mark on line below where qualified.
_______ Check here for 50 lights worked endorsement (cost is included with certificate)
_______ Check here for 100 members worked endorsement (cost is included with certificate)
Total amount enclosed in US currency (no IRC´s and NO Canadian Postal Money Orders) = $ ____________ Ck/MO number = _____________
(Make checks payable to Weidner Publishing.) All certificates require an SASE with 97 cents USA postage.
Fees are non-returnable.
REV: JUNE 2011