Click on "Download" below to download an application or print and complete the information below.
METRO DX CLUB – W9TY
www.metrodxclub.com
MEMBERSHIP REQUEST
(PLEASE PRINT) DATE_________________________
Name: ____________________________________________ Call: ____________________
Address: ______________________________________ License class: ___________________
City: ____________________________________ State : ______ Zip: ____________________
Phone: _____________________ E-Mail: _________________________________________
ARRL Member? Yes______ No______ Use LoTW? Yes _____ No ______
Number of DXCC Countries – Worked___________ Confirmed_____________
Amateur awards received: ___________________________________________________________________
Other Amateur Radio clubs you belong to:
________________________________________________________________________________________
Occupation: ________________________________________________________________
Main Interests for club activities are:
DXpeditions: _______ Field Day: ________ Contest operating: _______
I’m willing to serve as an officer or on club committees: YES ____ NO _______
Other interesting info: _________________________________________________________________
My other hobbies are: _______________________________________________________
Please complete and mail to: METRO DX CLUB, 3810 N. Chamlin Drive , Morris , IL 60450 USA
or complete and email to: w9ty@arrl.net
You will be contacted with information regarding your requested membership and US$15.00 annual dues.