300 Club Award Application Form

Great Lakes DX / Contest Club

300 Club

Application Form


* Applicant must have made contact and confirmed with the appropriate QSL cards of at least 300 DXCC countries.

* Applicant must complete the application form and have two other amateur radio operators verify that 300 DXCC countries have been confirmed.

Name____________________________________ Callsign____________

Address______________________________________________________

City, State ________________________________________,___________

Zip Code _________________

I have reviewed and hereby certify that the above applicant has worked-confirmed at least 300 DXCC countries and is eligible to receive the 300 Club Award.

Signature___________________________________ Callsign__________

Signature___________________________________ Callsign__________

I hereby state that I have worked and confirmed at least 300 DXCC countries and am eligible to receive the 300 Club Award.

Signature of applicant:________________________________

Date:____________

Return completed application form along with a donation of $5.00 which covers the costs to:

K9PXV-Great Lakes DX/Contest Club, 10058 Oak Island Drive, Laingsburg, Michigan 48848