KO6LU Award Application

KO6LU Award Name
Call Sign
Name
Address
City
State (Province)
Country
Postal Code

Select options and follow these procedures:

1. Application Status
  New Application (I do not have this award.)
       
  Upgrade (I have this award and am now applying for a higher level.)
    From: To:  
2. Type of Award (Select One)
  Confirmed (I have QSL cards from each contact.)
  Certification: The information and/or the QSLs required for this award have been checked and are certified to be correct by the following Radio Amateurs:
    Call Signature_____________________________________
    Call Signature_____________________________________
  Unconfirmed [I do not have QSL cards from each contact, but I declare that I have made proper two-way contact (or one-way reception for Short Wave Listeners) with all stations claimed for this award and have attached the proper log book extraction.]
3. Enclose $5.00 application fee.
4. Attach appropriate log sheet or electronic log extract.

I declare that all the necessary credits for this award have been obtained in accordance with the rules for this award, as well as the rules and regulations for amateurs in my country. Please accept this information and sent the award to my QTH as listed above.

Applicant's Signature_________________________________________ Date___________

Print, sign, and mail to: Bob Frostholm, KO6LU, 2060 Tripiano Ct., Mountain View, CA 94040 USA