WAC Award Application

Please print clearly and complete all sections

Name ____________________________________________________________________________ Callsign _______________________ Mailing Address __________________________________________________________________________________________________ City/Town_______________________________________________________ State_________________ ZIP Code ______________ Country:__________________________________________ Email Address: ______________________________________________ This application is for: Basic certificate CW certificate Phone certificate Image certificate Digital certificate Satellite certificate 5-band WAC 5-band endorsement 6-band endorsement QRP endorsement (5 watts output or less) 1.8 MHz endorsement 3.5 MHz endorsement 50 MHz endorsement 144 MHz endorsement 430 MHz endorsement 1270 MHz endorsement

Other Band(s) _______________________

Cards not listed below can be found in my DXCC account*

*(You must list the callsigns of the QSOs from your DXCC account that you want to claim) I am claiming credit for the following stations. Enter band(s) and callsigns: ( ) MHz ( ) MHz ( Note Band Info

) MHz

) MHz

) MHz

North America South America Oceania Asia Europe Africa

I have read all of the program rules and have complied with all program rules and governmental regulations regarding amateur radio in my country. Signature_______________________________________ Callsign __________________ Date ______________________ ARRL Member (circle one) YES NO

For non-USA applicants, applications should be presented to the local IARU awards manager for verification. The awards manager will handle all WAC applications. Approved DXCC card checkers can also verify application for WAC. (See www.arrl.org/awards/dxcc for the complete listing of approved card checkers). I am a member of __________________________________________IARU member society (Membership is required) Applicant is responsible for return postage for cards. Application forms with cards credited in a DXCC account can be sent to WAC by e-mail or fax along with payment noted on the form. Send application form, fees and QSL cards to: ARRL Awards Branch 225 Main Street Newington, CT USA 06111 Send comments and questions to wac@arrl.org Fax: (860) 594-0346 WAC Award Fees (per certificate) multiple awards/emdorsements can be placed on one certificate: $ 13.00 WAC Certificate $ 13.00 5B WAC Certificate $ 7.50 - Endorsements Check or Money Order Enclosed in the amount of ________________________ Credit Card # ________________________________________________________ ___________________________________________________ Awards Manager Verification Signature Exp Date _______________________

_____________________ Date April 2009