ARRL INTERNATIONAL PHONE DX CONTEST
                           
                            
  
CALL USED _______________________  ARRL SECTION _____________________
  
CALL OF OPERATOR IF DIFFERENT FROM CALL USED_________________________

Separate logs and summaries must be submitted for each mode of operation.
    
Entry Category:  Select ONLY ONE:              Valid QSOs      Entities
                                       +----------------------------------+
  [ ] Single Operator All Band QRP     | 160 |             |              |
  [ ] Single Op All Band Low Power     |----------------------------------|
  [ ] Single Op All Band High Power    |  80 |             |              |
  [ ] Single Op All Band Assisted      |----------------------------------|
  [ ] Single Op Single Band            |  40 |             |              |
      (circle band and power):         |----------------------------------|
      160  80  40  20  15  10          |  20 |             |              |
      QRP    Low   High                |----------------------------------|
  [ ] Multioperator Single Transmitter |  15 |             |              |
  [ ] Multioperator Two Transmitters   |----------------------------------|
  [ ] Multioperator Unlimited          |  10 |             |              |
				       |==================================|
                                       |Total|             |              |
  			               ------------------------------------
  			               |HOURS OPERATED:                   |
                                       +----------------------------------+
If multioperator, calls of all operators and loggers must be shown:
_____________________________________________________________________


____________ X 3 = ____________ X ___________ = ____________________
 Valid QSOs         QSO Points     Entities        Claimed Score
  
HOURS OPERATED: _______ 

POWER OUTPUT: [ ] 5 watts or less   [ ] 6-150 watts   [ ] Over 150 watts

+-------------------------------------------------------------------+
| Club participation?   Yes_____  No_____                           |
| ARRL Affiliated Club:_____________________________________________|
+-------------------------------------------------------------------+

"I have observed all competition rules as well as 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 
ARRL Awards Committee."

Please enclose log, photos, comments, ideas, etc. with your entry and
mail within 30 days after the contest to: Int. DX Phone, ARRL Contests, 
225 Main Street, Newington, CT 06111.

Email: dxphone@arrl.org                 WWW: www.arrl.org/contests

  
Date __________ Signature _______________________ Call _____________
  
NAME________________________________________________________________
  
ADDRESS_____________________________________________________________

____________________________________________________________________

Email Address:  ____________________________________________________