QRP DXCC AWARD APPLICATION
    	           (Required along with attached QSO list)

Directions: Please print clearly. (Number pages below)
Do not include QSL cards with this application.
Call Sign  __________________________________________________________
Ex Calls   __________________________________________________________
Name   ______________________________________________________________
         Last                                       First
Mailing Address _____________________________________________________
                     (Number and Street)   		
                _____________________________________________________
                    (City, State/Country, ZIP)
                 This is where your certificate will be sent                		 	
	
Name  _______________________________________________________________
(Print name clearly exactly as you want it to appear on certificate)
 
___ Credit Card # and Exp. Date _____________________________________     
___ U.S. Currency ________________  ___ Check or Money Order ________ 

"With my signature below, I affirm that I have observed all DXCC rules 
as well as all pertinent governmental regulations established for Amateur 
Radio in my country. I affirm that all contacts for this award have been 
made using a transmitter power of 5 watts or less. I agree to be bound by 
the decisions of the ARRL Awards Committee, and that the decisions of the 
ARRL Awards Committee shall be final."

________________________________________________________________________
Signature                                                     Callsign                                              Date

Send application forms and fee to:  DXCC Desk, ARRL HQ, 225 Main Street, 
Newington, CT 06111, USA
Telephone:   860-594-0234   Fax:  860-594-0346 (24 hour direct line to 
ARRL HQ)     Email:  dxcc@arrl.org   web:  www.arrl.org/awards/dxcc   
Thank you for your cooperation and Good DX!	

			QRP DXCC Program Rules
1)  The QRP DXCC Award certificate is given for working 100 different DXCC 
    entities on the DXCC List while operating with a transmitter power of 5 
    watts or less. 
2)  Applications will be accepted beginning January 2, 2002. Contacts may 
    have been made at any time since November 15, 1945.
3)  This award is not endorseable. Certificates will be dated, not numbered.
4)  The applicant must certify the authenticity of log information for 
    contacts with 100 entities using 5 watts or less. No QSL cards are 
    required for this award. 
5)  This award is separate and distinct from the traditional DXCC award 
    program. Credits are notassigned to other DXCC awards.
6)  This award is available to all Amateur Radio operators anywhere in the 
    world. 
7)  The standard DXCC rules apply to this award.
8)  The award application and an alpha-numeric list of 100 contacts is 
    required in order to facilitate processing. 
9)  The fee for this award is $10. This includes all postage and handling 
    fees.
10) Faxed and web applications must be accompanied by a credit card number 
    for payment.    				        	MSD (02/06)