Worked All New York Counties Award Application Sponsored by the RZS Solutions, Inc. Amateur Radio Club  W2RZS

Name______________________________  Call Sign_______________  Date______________

E-mail Address ________________________________________________________________

Mailing Address _______________________________________________________________

City _______________________ State_______  Zip ___________ Country________________

I certify that all of the information submitted for the Worked All New York Counties Award is correct.  I acknowledge that the WANYC award manager reserves the right to verify any claimed QSOs validity from the station claimed for credit.

Signed  ____________________________________________  Call Sign ________________

Complete the Worked All New York Counties Award Application, and mail with $5.00 (cash or USPS money order) or 5 valid IRCs to:

Robert S. Schaps, WB2NVR

RZS Amateur Radio Club

37 Saw Mill River Road

Hawthorne, NY  10532-1552

U. S. A.