I Want to Join WNYDXA! *

First Name: *


Last Name *


Callsign: *


Address: *


City: *


State/Province: *


Zip Code: *


Phone #: *


Your Email: *


I was referred for membership by:


My present shack consists of the following DX-chasing gear: *


My antenna farm consists of the following: *


Please describe your main DX activities (Contests, CW, IOTA, DXpeditions, etc.): *


I am presently active on the following bands: *


My present country count is in the range of: *
0 - 100
101 - 200
201 - 300
301 +

Any comments for the Membership Committee?