TEXAS DX SOCIETY
Application for Membership

The membership dues annual rate is $25 or $12.50 for a member more than 75 miles (your best estimate) from Grid Square EL29HS (downtown Houston, TX).

Membership dues are for one calendar year prorated monthly. Complete the following online form and click on the "Submit" button.

Send payment via PayPal or personal check. PayPal is much preferred.

PayPal payable to This email address is being protected from spambots. You need JavaScript enabled to view it.

Add a Note: TDXS membership dues from (your callsign).

Personal check payable to the Texas DX Society.

TDXS TREASURER
1614 FAIR OAKS LANE
RICHMOND TX 77406-1388

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TDXS Officers,

This TDXS Membership Application was completed by a prospective TDXS candidate.

SECRETARY, please notify the BoD Reflector that the application is complete, as necessary, and in order. If not, ask the applicant to update and resubmit the application.

TREASURER, please notify the BoD Reflector when you receive the applicant's payment.

VP MEMBERSHIP, please welcome the new member and notify the BoD Reflector that you have done so.

NEWSLETTER EDITOR, please make note of the applicant's birth month if provided on the application.

CONTEST CHAIRMAN, please notify the BoD Reflector that the new member was added to the ARRL Club Competition Eligibility List. (if applicable)

WEBMASTER, please notify the BoD Reflector that the TDXS website is updated.

MEMBERSHIP APPLICATION FOLLOWS

Date

Name

    

Nickname

Callsign*

Year First Licensed*

Previous Callsign(s)

Address

AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSabaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSint EustatiusSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

Home Phone - Cell Phone - Work Phone

-

-

Email*

QRZ.COM Email if any

1. Describe your principal amateur radio interest:

2. Do you currently have a station on the air?

Yes

No

Previously

2A. If so, briefly describe your station, indicating the bands and modes you operate on most frequently:

3. Do you now hold an ARRL DXCC Certificate?

Yes

No

3A. What is your total ARRL countries worked?

3B. Countries confirmed?

4. Do you regularly participate in radio contests?

Yes

No

4A. If so, what contests and modes?

5. Are you a member of the ARRL?*

Yes

No

Previously

5A. List other radio societies and clubs of which you are a member:

6. Are there other amatuer radio operators in your family?

Yes

No

6A. If so, please list their names and call signs:

7. Please list any other hobbies or interests you care to disclose:

8. Month of Birth (OPTIONAL)

9. Please list an emergency contact. (OPTIONAL)

    

9A. Emergency contact phone. (OPTIONAL)

Applicant signature:*

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