TCDXA Membership Application

Complete this form online and email to the TCDXA using the SUBMIT button at the bottom of this page.
If you prefer, you can print the completed form, using the PRINT THIS PAGE button, and mail it to the address listed below.
                  

Name:    Callsign:      Current age:     Date:

Address: City: State: Zip: Country:

Phone (home): (mobile): (work):   Email address:

DX/other callsigns:   Personal web page:
                 
I am currently a member of:      ARRL       MWA      NCDXF       INDEXA       Others:

I've been issued the following DX Award Certificates by the ARRL, CQ, and IOTA (none required for membership):

Mixed DXCC                                     Mixed DXCC Honor Roll                                             DXCC Challenge

SSB DXCC                                        SSB DXCC Honor Roll                                                5BWAZ

CW DXCC                                         CW DXCC Honor Roll                                                 IOTA
            
RTTY DXCC                                      RTTY DXCC Honor Roll                                              LoTW user                        

6M DXCC                                          #1 DXCC Honor Roll                                                  Others:

160M DXCC                                      5BDXCC

Referring member (if applicable):  Callsign: Date:

By submitting this application I agree to abide by the bylaws of TCDXA.

Your contribution to TCDXA is used to fund qualified DXpeditions. Please consider a minimum contribution of $25 for yearly membership. Larger amounts are welcome and greatly appreciated. But, so are lesser amounts. Please contribute an amount that fits your budget. TCDXA is a non-profit organization as described in Section 501(c)(3) of the Internal Revenue Code. All contributions are tax-deductable to the extent permitted by law. Use the PayPal and Credit card link on the home page or make a check payable to TCDXA and mail to the Interim Secretary/Treasurer:  Jim Junkert, KØJUH, 4462 161st Lane, NE, Ham Lake, MN 55304
                                                                                                  

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