|
|
                
| 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 13 and 15 entities. Endorsement to original award US$3.00 for #14 or #15. A SPECIAL HISTORIC award is available for those contacting the ORIGINAL SIXTEEN DXCC territories including Kingman Reef (KH5K). 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_____ 7. KH5 Palmyra & Jarvis ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 8. KH5K Kingman Reef ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ (DELETED 01APR2016) 9. KH7K Kure Island ________________ _________ _________ ____ ______ QSL Card ____ LoTW_____ 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
|