Transcription of DXCC Challenge Plaque
1 dxcc Challenge Plaque / Lapel Pin Order Form The american radio Relay league 225 Main Street Newington, Connecticut, USA 06111 Phone: 860-594-0200 Fax: 860-594-0346 E-mail: Congratulations! Now that you have qualified for the dxcc Challenge , you can proudly display this accomplishment on your shack wall. To order the Plaque , please complete and return this form to the dxcc Desk at the address above. You can also order by phone, fax or e-mail. Please allow 4-6 weeks for delivery in the US and Canada and 6-8 weeks for foreign delivery. Thank you for your support and continued interest in the dxcc Program. PLEASE CLEARLY PRINT NAME AND CALLSIGN (AS YOU WANT THEM TO APPEAR ON THE Plaque ) AND YOUR COMPLETE MAILING ADDRESS BELOW Callsign _____ Name _____ (as to appear on Plaque ) Address _____ _____ City _____ State _____ Postal Code _____Country _____ E-mail Address _____ Telephone# _____ I qualify for THE dxcc Challenge Plaque .
2 Please send me: ___Challenge Plaque USA - $97 // Canada - // Other non-USA - $ (All shipping included) ( Plaque includes #1000 level medallion) (Shipped by FedEx) ___ Lapel Pin ($ Includes shipping) ___ Endorsement Medallion ($ US / $ foreign includes shipping) _____ #1500 ____#2000 ____#2500 ___ #3000 Endorsement Medallion ($ plus shipping) I enclose: ____ Check ____ Money Order ____ Cash ____ Credit Card for the amount of _____ ____ Master Card (incl. EuroCard) ____VISA ____ Discover ____ AMEX ____ Other (please specify) _____ Account/Card# _____ Expiration Date: _____ . Unless otherwise specified, we ship Fedex in the US and Registered mail elsewhere. Please make checks payable to: american radio Relay league .
3 (USA bank only). Do not send cash. ARRL is not responsible for cash sent by mail. ARRL is NOT responsible for plaques lost in shipment that are not sent via a traceable method (such as Registered Mail, Fedex, DHL, or UPS). Signature: _____ Date: _____ 2014
