* 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