Return the Following portion for your next upgrade

Basic #      :   
10-10 #      :  
Callsign     :  
Name         :  
Address      : 
City         :  
ST           :  
Zip Code     :
Country      : 
County       : 
Email        :  
 

On Air Collected points   Total: _________

Portland 500 Contacts     Total: _________
 

Lead Car List (add lines as required)

Lcar#    Date       Callsign     County                 ST

____     _____      _______     _________            ___

 

Lap # 1 Seals Collected Total: _________

Lap # 2 Seals Collected Total: _________

Lap # 3 Seals Collected Total: _________

Lap # 4 Seals Collected Total: _________

Lap # 5 Seals Collected Total: _________

Lap # 6 Seals Collected Total: _________

Lap #7 Seals Collected Total:  _________

WAS Seals Collected Total: _________

TN Traveler Seals Collected Total: _________

MP Convention Seals Collected Total: ________

Pit Crew Member Seals Collected Total: _______
===============================================