President: Robert Adamitis K9MDO

Vice-President: John Holmes W9ILY

Secretary/Treasurer: Jack Nienhaus W9NJB

Webmaster: John Holmes W9ILY

Log Extract

From: ___________________

_________________________

_________________________

To: METRO DX CLUB

5045 Oak Center Dr

Oak Lawn, IL 60453

USA

Application for: ______________________________________________________________________________

Awards fee enclosed: _____________________________

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 and Callsign

________________________ ___________

Signature and 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: ____________________________________

Date: ___________

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No.     Call     Date     Time  Band  Mode   RST

1. _______ ______ ______ _____ _____ _____

2. _______ ______ ______ _____ _____ _____

3. _______ ______ ______ _____ _____ _____

4. _______ ______ ______ _____ _____ _____

5. _______ ______ ______ _____ _____ _____

For further information, email w9ily@arrl.net

Metro DX Club

5045 Oak Center Drive

Oak Lawn, IL 60453

U.S.A.

To contact us, please email: membership@metrodxclub.com