Callsign ____________________________________
Name_________________________________________
Street_______________________________________
City ________________________________________
State _______________________________________
Phone _______________________________________
Prev call/s__________________________________
DXCC Totals__________________________________
E-Mail_______________________________________
Homepage_____________________________________
Station Capabilities
Antennas & Type__________________________________________
Logging Programs Used __________________________________
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Tower/s__________________________________________________
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Transceivers_____________________________________________
Specific Titles & Numbers________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
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Amplifiers/Power_________________________________________
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_________________________________________________/______W
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Member WDXA Nr______
Approved by _________________________
William T. Allen, N6XD President WDXA
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