Award Application

 

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Metro DX Club Officers

President: Jim Mornar, N9TK

Vice-President: Bob Jacobson K9CJ

Acting Recording Secretary: John Raiger, K9DRS

Secretary/Treasurer: John Holmes, W9ILY

Webmaster: John Holmes, W9ILY

 

WUST Award Application updated 01 April 2017

From: ______________________________________________

____________________________________________________

____________________________________________________

Email address:________________________________________

To: METRO DX CLUB

3810 N. Chamlin Drive

Morris, IL 60450

USA

Application for award: (INDICATE below with an "X" THE AWARD YOU WANT)  (Click on award name to see a sample and for rules)

W.U.S.T. AWARD (US$8.00)_______  Original award US$8.00 between 11 and 13 entities. Endorsement to original award US$3.00 for #12, #13, #14 or #15. A SPECIAL HISTORIC award is available for those contacting the ORIGINAL SIXTEEN DXCC territories including Kingman Reef (KH5K), Midway (KH4) and Kure (KH5).      

METRO GOLD CERTIFICATE (US$5.00)_______

Awards fee: US$____________________ enclosed. A PayPal payment to w9ty@arrl.net is also accepted. 

The information and/or QSL cards required for this award have been checked and are certified to be correct by the following radio amateurs:

_______________________________________________  _______________   

Signature                                                                         Callsign

_______________________________________________  _______________

Signature                                                                         Callsign

I declare that all the necessary credits for this award have been obtained in accordance with the rules of the award, as well as the rules and regulations for radio amateurs in my country. Please accept this information and send the award to my QTH as listed above.

Applicant's Signature: ________________________________________________    Callsign:___________________

Date: ________________

I learned about this award from (please let us know!): __________________________________________________________________________________________

NOTICE: For the W.U.S.T. Award, if you are at the TOP OF THE ARRL DXCC HONOR ROLL as printed in the most recent QST (normally the August edition), you automatically qualify for the award without having to send copies of QSL cards. You must write "TOP OF THE ARRL DXCC HONOR ROLL IN QST AUGUST 2010" (or the most current year of QST) on this Award Application in the "QSO Data" section below. This applies ONLY to those who are at the VERY TOP of the ARRL DXCC Honor Roll.

Photocopies of QSL cards are OK. 

For an LoTW confirmation, it must be verified by two amateurs as does a QSL card, or a copy of the screenshot of the LoTW QSL confirmation detail may be substituted.

QSO data:

           Territory                  QSO                                                                                Indicate with "X" the

No.   Prefix/Name              Callsign                Date        Time         Band   Mode            Type of confirmation

1. KG4 Guantanamo Bay   ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

2. KHØ Mariana Islands    ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

3. KH1 Baker & Howland  ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

4. KH2 Guam                        ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

5. KH3 Johnston Island      ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

6. KH4 Midway Island      ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____ (DELETED 26AUG2016)

7. KH5 Palmyra & Jarvis    ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

8. KH5K Kingman Reef   ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____ (DELETED 01APR2016)

9. KH7K Kure Island          ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____ (DELETED 26AUG2016)

10. KH8 American Samoa  ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

11. KH8S Swains Island     ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

12. KH9 Wake Island          ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____ 

13. KP1 Navassa Island      ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

14. KP2 US Virgin Islands  ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

15. KP4 Puerto Rico            ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

16. KP5 Desecheo Island    ________________ _________ _________ ____ ______     QSL Card ____   LoTW_____

 

For further information, send an email to: awards@metrodxclub.com

 

Metro DX Club

3810 N. Chamlin Drive

Morris, IL 60450

U.S.A.

To contact us, please email:    w9ty@arrl.net

MEMBER:

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