Appalachian Trail Award    Log for the Basic Award

            Your Call ____________

CT        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

GA        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

MA        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

ME        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

MD        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

            Appalachian Trail Award    Log for the Basic Award

            Your Call ____________

NC        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

NH        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

NJ        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

NY        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

PA        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

            Appalachian Trail Award    Log for the Basic Award

            Your Call ____________

TN        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

VA        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

VT        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

WV        Call _________    Date ___/___/____    Time ____:____ UTC    Band ____

              RS(T) Sent ____        RS(T) Rcvd ____

              QTH _____________________________________________________________

            Appalachian Trail Award    Log for the Basic Award

            Your Call ____________

Name ______________________________________________    Call ________________

Address __________________________________________________________________

City ________________________________________________

State _____    Zip Code _________-______

"I have observed all Appalachian Trail Award 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 Eastern PA QRP Club Committee"

Date ___/___/____    Signature __________________________________________