ADXA Information Form

Please enter any stats or information about yourself that needs added or changed

NAME

First Last

Callsign

Address

City State Zip

Email Address

URL - Web Page, Personal or Club

DXCC Stats

DXCC Honor Roll  Yes  No

Top of Honor Roll  Yes  No

# Countries Confirmed /  include Deleted Countries on Mixed Total

DXCC Mixed   DXCC Active    DXCC Phone    DXCC CW    RTTY 

DXCC How Many Bands 

160M    80M    40M    30M    20M    17M    15M    12M 

10M    6M    2M 

COMMENTS