North America Award Application Form

Please complete the application form and sign the declaration below.

	Station	Mode	Date	Country
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Declaration: "I certify that I have read, understood and complied with the spirit and rules of the North America award. All the claimed contacts were considered complete by both stations. My station was operated within the current terms of my license".

Name:

Address:

Callsign:

Membership Number:

Date:

Signature:

Please complete this application form and sign the declaration above.
Please keep a copy of entry form as it cannot be returned!
Send the forms together with your remittance to the awards manager.
Please make cheques payable to "UKSMG".

The UKSMG Awards Manager
Peter Kay, G0KUX
90 Avenue Road
Southgate
London
N14 4EA
UK

To return to the North America Award page click here