Name ____________________________________
Mailing _________________________________ Home _____________________________________
Address Address
_________________________________________ __________________________________________
Do you want your address printed in the membership list? Mailing _____ Home _____
Phone number at work ___________________ at home _____________________
Do you want other DXers to phone you at home? ______ work ______
If so, when it the best time? Home _____________ Work ________________
Age _______ Occupation ____________________________________________________
What other radio related clubs are you a member of? _____________________________________
What bands do you mainly DX? ___________________________________________________________
sometimes DX? _________________________________________________________
want to DX, but no time or equipment? _________________________________
When did you start DXing? _____ What are your totals (stations/states/countries) _______
Please list your receiver(s) (include portables as well): _______________________________
_________________________________________________________________________________________
Please list your antenna(s): ____________________________________________________________
_________________________________________________________________________________________
What other exotic equipment do you own and regularly use? (tape recorders, audio filters,
tuners, etc....)
_________________________________________________________________________________________
Would you be willing to write a review describing any of your equipment? ______
Are you interested in attending (being informed of) local DXer get-togethers? ______
If so, what days and times are best for you? ________________________________________
Can you hold a local get-together at your home or arrange for one in your area? ______
If so, when is the best time of year? _______________________________________________
Are you interested in attending (or arranging for) a DXpedition? ______
Are you interested in being a part of a DX hot line? ______
Do you collect radio paraphernalia? ______ If so, what? ________________________________
What are some of your other interests? __________________________________________________
_________________________________________________________________________________________
Do you know of anyone else who might want to be part of this club? ______
Please forward the names and addresses to club HQ or email: bytheway@atk.com
Last Modified: Wednesday, March 20, 1996 17:57 GMT