OM INTERNATIONAL SIDEBAND SOCIETY
AWARDS APPLICATION

This form may be used for applying for all awards and endorsements offered by the OMISS. Please print or type all information and sign in the space provided.

Award/endorsement being applied for:	_______________________	Applicant's Call Sign	________________OM #:_______
If applying for endorsement, Please Provide Original Award Number: ____________

Name: __________________________________   (As it is to appear on certificate)

Address: ______________________________________

City: _______________________ State: _______________ Zip: ______________

Attach to this application one or more log reporting sheets listing the contacts to be used to qualify for this award. Please indicate page number, call, and name of award being applied for on each sheet.

For WAS-type awards: All entries must be listed in alphabetical order by state.

For DX-type awards: Enter name of country of station worked in column marked "additional information." List alphabetically by country.

For USA-Counties Award: All entries must be listed in alphabetical order by state. Once the states are sorted alphabetically, sort the counties in alphabetical order in their respective state.

For WPX Award: Sort by Call Sign prefix starting with A-Z (1x Calls) then AA-ZZ (2x Calls).

ALL OTHER AWARDS: SORT BY OMISS MEMBERSHIP NUMBER

QSL's are required for the following: WAS-OM Award and endorsements; DX Award and endorsements; DXCC Award and endorsements; 5 Band DXCC and endorsements; 5 Band WAS; WAS Base/Mobile Award, WAS Mobile Award, and Canadian Provinces Award.

Cost: All awards require the payment of a $3.00 admin fee. All endorsements require a $2.00 fee. In addition, all applicants sending QSL cards must include enough postage to cover the cost of returning the cards. QSL cards sent without return postage will not be returned. Checks should be made payable to OMISS. Completed applications, fees, and required QSLs are sent to:

OMISS Awards Manager
KA0AK
DICK ZENGE
524 N. Russell
Snohomish WA 98290

I certify that the information provided is correct and that all contacts were made on OMISS frequencies during net times.

Signed: ______________________________________    Date: ________________