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Metro DX Club Officers President: Bob Jacobson, K9CJ Vice-President: Phil Snyder, N9LAH Secretary/Treasurer: John Holmes, W9ILY Webmaster: John Holmes, W9ILY Contest Chairman: Jim Anderson, NV9X | Award Application From: __________________________________________ ________________________________________________ ________________________________________________ Email address:____________________________________ To: METRO DX CLUB 3810 N. Chamlin Drive Morris, IL 60450 USA Application for award: (CHECK ONE) W.U.S.T. AWARD ______ METRO GOLD CERTIFICATE_____ (Click on award name to see a sample and for rules). Awards fee enclosed: US$______________________ Number of valid IRCs _________ 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: ________________ 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. Name or Prefix Callsign Date Time Band Mode Type of confirmation 1. ________________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 2. ________________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 3. ________________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 4. ________________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 5. ________________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 6. ________________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 7. ________________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 8. ________________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 9. ________________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 10. _______________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 11. _______________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 12. _______________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 13. _______________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 14. _______________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 15. _______________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 16. _______________ ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ For further information, send an email to: awards@metrodxclub.com
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Metro DX Club 3810 N. Chamlin Drive Morris, IL 60450 U.S.A. To contact us, please email: w9ty@arrl.net
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