DXCC AWARD APPLICATION Required with Each New Submission and Endorsements. Please print clearly. Please complete all sections. I am applying for the following DXCC Award(s) / Endorsements: ___ New Award(s) ___ Endorsement(s) ___ I submitted an application via LoTW ___ # of QSL Cards Enclosed ___ # of QSOs You must mark those qsos on your cards for which you wish credit. Cards must be sorted according to the guidelines (See FAQs at: http://www.arrl.org/awards/dxcc/faq) Call Sign __________________________ Ex Calls __________________ Name ______________________________________________________________ Last First Mailing Addresss _________________________________________________ __________________________________________________________________ __________________________________________________________________ (City, State, Zip. Country) The above address is where your paperwork, cards, and/or certificate will be shipped _____ Check here if new address Name on Certificate ________________________________________________ Print exactly as you want it to appear on certificate Email Address: ____________________________________________________ Telephone # ________________________________________________________ Are you a Diamond Club Member: ____ Yes ____ No Return My QSL Cards Via: * ___ Registered (Recommended) ____ Certified (US Only) ___ First Class (US) ____ First Class Intern (foreign) ___ Fedex * If left blank, we will ship via Registered Mail at your expense Complete DXCC fees are shown at: www.arrl.org/awards/dxcc • The use of a current DXCC application form is required • Do not use this form for plaque or pin orders • Return postage is required for the return of cards and all written requests • DXCC accepts most credit cards. If you are not sure of the correct charges, you may use a credit card. This will allow us to charge the exact amount. You must clear previous balances (per your last credit slip) with this submission in order to avoid delays. • DXCC cannot bill you. "I affirm that I have observed all DXCC rules as well as all governmental regulations established for Amateur Radio in my country. I understand that ARRL is not responsible for cards handled by DXCC Card Checkers and will not honor any claims. I agree to be bound by the decisions of the ARRL Awards Committee and that all decisions of the ARRL Awards Committee are final." _____________________________________________________________________ Signature (REQUIRED) Callsign Date _____________________________________ ARRL Membership Expiration Date Send application forms, QSL cards, fees, and return postage to: DXCC Desk, ARRL HQ, 225 Main Street, Newington, CT 06111, U.S.A. For questions or clarifications, please write to the DXCC Desk at the above address, or via e-mail to dxcc@arrl.org To confirm the receipt of your application, go to this link: www.arrl.org/awards/dxcc/appstatus.html. The DXCC Desk can also be contacted as follows: Telephone: 860-594-0234, Fax: 860-594-0346 (24 hour direct line to ARRL HQ). For complete program information, please visit the DXCC web site at: www.arrl.org/awards/dxcc For ARRL DXCC Card Checker Use Only I affirm that I have personally inspected the confirmations and verify this application is accurate. _______________________________________________________________________ Signature Callsign Date DXCC Card Checkers must forward the application and fees to HQ within 2 working days. FIELD CHECKED APPLICATIONS MAY BE SUBMITTED ONLY BY CARD CHECKERS. PAYMENT DETAILS ____ Check or Money Order Enclosed in the Amount of $_____________; or ____ Credit Card # ____________________________________________________ Exp Date: _________________ DXCC Record Sheet Your Callsign: ____________________________ Page ______ of _______ Note: Cards may be submitted directly to ARRL or checked by a DXCC Card Checker. If cards are sent direct to ARRL, it is not necessary to fill out this form. This form must be completed if a Card Checker checks the application. In either case, the cards or listed credits must be sorted first by band then by mode. If you fill out the form, supply all information as requested. Be sure to use the Entity name, not just the prefix. Cards indicating multiple contacts must be placed together. If cards with multiple credits are submitted direct to ARRL, a notation must be made on each card indicating which credits are to be entered. If no indication is made on a card, all credits will be entered into your record. _________________________________________________________________________ | QSO Date | | | Callsign | DD/MM/YY | Band | Mode | Entity Name _________________|__________________|________|_________|__________________ 1_______________ | _____ /____/_____| ______ | _______ | _________________ 2_______________ | _____/____/_____ | ______ | _______ | _________________ 3_______________ | _____/____/_____ | ______ | _______ | __________________ 4_______________ | _____/____/_____ | ______ | _______ | __________________ 5_______________ | _____/____/_____ | ______ | _______ |___________________ 6_______________ | _____/____/_____ | ______ | _______ | __________________ 7_______________ | _____/____/_____ | ______ | _______ | __________________ 8_______________ | _____/____/_____ | ______ | _______ | __________________ 9_______________ | _____/____/_____ | ______ | _______ | __________________ 10______________ | _____/____/_____ | ______ | _______ | __________________ 11______________ | _____/____/_____ | ______ | _______ | __________________ 12______________ | _____/____/_____ | ______ | _______ | __________________ 13______________ | _____/____/_____ | ______ | _______ | __________________ 14______________ | _____/____/_____ | ______ | _______ | __________________ 15______________ | _____/____/_____ | ______ | _______ | __________________ 16______________ | _____/____/_____ | ______ | _______ | __________________ 17______________ | _____/_____/____ | ______ | _______ | __________________ 18______________ | _____/____/_____ | ______ | _______ | __________________ 19______________ | _____/ ____/____ | ______ | _______ | __________________ 20______________ | _____/ ____/ ____| _____ | _______ | __________________ 21______________ | _____/_____/____ | ______ | _______ | __________________ 22______________ | _____/____/_____ | ______ | _______ | __________________ 23______________ | _____/ ____/____ | ______ | _______ | __________________ 24______________ | _____/ ____/ ____| _____ | _______ | __________________ 25______________ | _____/ ____/ ____| _____ | _______ | __________________