The author of this form is Dan Henderson, N1ND at contests@arrl.org
March 9, 2004


                   IARU HF WORLD CHAMPIONSHIP

Administered by the ARRL

Please enclose log, dupe sheets and photos and mail to:
IARU HF World Championships, Box 310905, Newington CT 06111

Call Used: ____________________ Call of Operator: __________________

___ Single Operator Mixed Mode                  ___ QRP  < 5 Watts
___ Single Operator Phone Only		        ___ Low  < 150 Watts
___ Single Operator CW Only		        ___ High > 150 Watts
___ Multioperator  			            Select only one
___ IARU Headquarters Station
___ IARU Official
        Check only one

ITU Zone Sent: ________________ or IARU HQ Sent: ___________________

ARRL Section or DXCC Entity: ___________________________

If Multioperator, list calls of all operators and loggers:

____________________________________________________________________

____________________________________________________________________
 
____________________________________________________________________
      |   CW ONLY     |   PHONE ONLY  |  CW and PHONE |    BAND    | 
      | QSOs   POINTS | QSOs   POINTS | QSOs   POINTS | MULTIPLIERS|
+-----+-------+-------+-------+-------+-------+-------+------------+
| 160 |       |       |       |       |       |       |            |
|-----|-------|-------|-------|-------|-------|-------|------------|
| 80  |       |       |       |       |       |       |            |
|-----|-------|-------|-------|-------|-------|-------|------------|
| 40  |       |       |       |       |       |       |            |
|-----|-------|-------|-------|-------|-------|-------|------------|
| 20  |       |       |       |       |       |       |            |
|-----|-------|-------|-------|-------|-------|-------|------------|
| 15  |       |       |       |       |       |       |            |
|-----|-------|-------|-------|-------|-------|-------|------------|
| 10  |       |       |       |       |       |       |            |
|=====|=======|=======|=======|=======|=======|=======|============|
|TOTAL|       |       |       |       |       |       |            |
+---------------------------------+--------------------------------+

Total QSOs: _____________________  
Total QSO Points: _______________ 
Total Multipliers: ______________

QSO Points     x Multipliers  =  Claimed Score
______________ x ____________ =  _____________

"I have observed all competition rules as well as all regulations for 
Amateur Radio in my county.  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, acting on behalf of the IIARU Secretariat."

Name: ________________________________________  Call: __________________

Address: _______________________________________________________________

________________________________________________________________________

Email: _________________________________________________________________