Provide all of the requested information on the form
below, following the instructions on the reverse. Use a separate
form for each badge order. (Photocopies of this blank form will
be accepted).
NAME:___________________________________ CALL SIGN:_____________
(as it should appear on the badge -- PRINT LEGIBLY)
STREET ADDRESS:_______________________________________________
CITY__________________________________STATE_______ZIP__________
Daytime Phone:______________ Evening Phone:______________
E-mail address: _________________________
ARRL SECTION:____________________________
(only if
you are a Section-Staff, Station, Emergency Communications or
NTS Leadership appointee)
ARRL DIVISION:____________________________
(only if
you are an Assistant Director, Advisory Committee Member, QSL
Bureau Manager/Worker, Technical Advisor, Volunteer Counsel, Volunteer
Consulting Engineer, Volunteer Examiner, ARRL Monitoring System
appointee, Awards Manager, DXCC Field Reps, or Life Member)
APPOINTMENT:___________________________
(see eligibility
table
AUTHORIZED COLOR:_____________________
(see table)
CHOICE OF FASTENER:____________________________
AMOUNT ENCLOSED: $____________
Section Staff Appointees -- GREEN
Assistant Section Manager, Affiliated Club Coordinator, Bulletin Manager, Official Observer Coordinator, Public Information Coordinator, Section Emergency Coordinator, Section Traffic Manager, State Government Liaison, Technical Coordinator
Station Appointees -- BLUE
Official Observer, Official Emergency Station, Official Relay Station, Technical Specialist, Official Bulletin Station, Public Information Officer, Local Government Liaison
Emergency Communications Appointees -- ORANGE
District Emergency Coordinator, Emergency Coordinator, Official Emergency Station, Assistant Emergency Coordinator
NTS Leadership Appointees -- LIGHT GREEN
NTS Area Staff, Net Manager
Division Appointees -- LIGHT BLUE
Assistant Director and Advisory Committee Appointee
Other Appointees
QSL Bureau Managers -- RUST
QSL Bureau Workers -- RUST
Technical Advisors -- BROWN
Volunteer Counsels -- PURPLE
Volunteer Consulting Engineer -- PURPLE
Volunteer Examiners -- TAN
ARRL Monitoring System -- BURGUNDY
Awards Manager -- GRAY
DXCC Field Representative -- GRAY
Life Member, Charter Life Member -- YELLOW