Call Used _____________________ State/Country/County ________________

This entry is for Mixed____   CW____  Mixed____  Mode____

Total Hrs of Operation ____      Check One Category and One Power Output Class below:

____ Single Operator                    ____ QRP (5 Watts output or less)
____ Multi-Op                              ____ Low Power (150 Watts output or less)
                                                  ____ High Power (more than 150 Watts output)
____ Rover Single Operator
____ Rover Multi-operator

Club Name (for Club Competition) ______________________________________

TOTAL QSO points _____  X  TOTAL multipliers = ____________ FINAL SCORE

" I have observed all competition 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 Georgia QSO Party Contest Committee."

Signature ______________________________________________ Date ________

Name ________________________________________ Call __________________
Address ____________________________________________________________
___________________________________________________________________
Email address _______________________________________________________

SEND YOUR LOGS and SUMMARY FORMS  VIA EMAIL OR POSTAL MAIL AS BELOW:

EMAIL to gqp@iham.us

Note: Both a log and summary are needed for postal entries.

POSTAL MAIL on or before the published deadline to: