The author of this form is Dan Henderson, N1ND     contests@arrl.org

	            ARRL INTERNATIONAL EME COMPETITION
  
Call Used ___________________________________________________________

ARRL Section ________________________________________________________

_____________________________________________
|  Operator Information - Check One:         |  				   
|  Single Operator Unassisted _______        |	
|  Single Operator Assisted _________        |   ______________________
|  Multioperator ___________________         |   | Was all equipment  |	
|  If multioperator, list additional 	     |   | amateur owned?     |
|  operator calls:  ________________________ |   |                    | 
|  _________________________________________ |   | ___  Yes           | 
|____________________________________________|   | ___  No            |
						 |____________________| 
_____________________________________________    
|					     |	
| Band Information - Check Only One          | 
|                                            |  
| All Band ________________________          |
|                                            |
| Multiband 50 - 1296 MHz _________          |
|                                            |
| Multiband 2304 and Up ___________          |
|                                            |            
| Single Band Only ________________          |
_____________________________________________|

______________________________________________________________________
|								     |	
|  ____________________   _________________   ___________________    |
|    QSOs (x 100)       X   Multipliers     =  Claimed Score         |
|____________________________________________________________________|

 
    Band            QSOs            MULTIPLIERS    
+--------------------------------------------------+
|   50  MHz  |                |                    |
|--------------------------------------------------|
|   144 MHz  |                |                    |
|--------------------------------------------------|
|   222 MHz  |                |                    |
|--------------------------------------------------|
|   432 MHz  |                |                    |
|--------------------------------------------------|
|   902 MHz  |                |                    |
|--------------------------------------------------|
|  1296 MHz  |                |                    |
|--------------------------------------------------|
|  2304 MHz  |                |                    |
|--------------------------------------------------|
|  3456 MHz  |                |                    |
|--------------------------------------------------|
|  5760 MHz  |                |                    |
|--------------------------------------------------|
|  10   GHz  |                |                    |
|--------------------------------------------------|
|  24   GHz  |                |                    |
|--------------------------------------------------|
|       Ghz  |                |                    |
|--------------------------------------------------|
|       GHz  |                |                    |
|--------------------------------------------------|
| Total      |                |                    |
----------------------------------------------------

Equipment Description:  

Tansmitter:  _____________________________________________________

Receiver:  _______________________________________________________

Antennas:  _______________________________________________________

Hours Operated:  _________________

Visit the ARRL Online Soapbox at www.arrl.org/contests/soapbox and 
upload your photos and soapbox for this contest.

"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."

Date _____________  Signature __________________________  Call __________
  

NAME__________________________________________________  CALL ____________
 
ADDRESS__________________________________________________________________

_________________________________________________________________________

Email Address:  _________________________________________________________


7/05