Expedition Donation Request - Kansas City DX Club

General: Expedition Group Name *

General: Expedition DXCC Entity *

General: Expedition Website/ URL: *

e.g. https://kcdxclub.org

General: Expedition Callsign (if Assigned)

General: Primary Contact Name *

First

Last

General: Primary Contact Callsign *

General: Primary Contact Email Address *

Email

Confirm Email

Funding: Total Cost Of Expedition (USD) *

Funding: Proposed Number of Operators/ Team Members/ Participants with a Required Financial Commitment

Selected Value: 1

Funding: Financial Commitment of Each Operator/ Team Member and/or Participant *

Funding: Other Funding Sources for Expedition

Funding: Excess Funds *

Team Members
Refunded to Sponsoring Organizations
Other

Please indicate how excess funds will be allocated

Funding: Excess Funds

If “Other” was selected above, please explain

Operation: Does the Expedtion have all applicable government permissions to operate? *

Yes
No

Operation: Will this Expedition be a 24 hour operation *

Yes
No

Operation: Start Date *

Please indicate the start date on which the Expedition will commence operations for the DXCC entity in MM/DD/YYYY format

Operation: End Date *

Please indicate the start date on which the Expedition will end operations for the DXCC entity in MM/DD/YYYY format

Operation: Proposed Number of Operators

Selected Value: 1

Operation: Bands of Operation *

Check all that apply

Operation: Modes of Operation *

Operation: Modes of Operation – Other

Please specify any planned modes of operation not listed.

Operation: Planned Number of Stations on Air

Selected Value: 1

Operation: Highest Powered Station (Watts) *

Less than or equal to:

Operation:Antennas: Number of Beams

Selected Value: 0

Number of beam antennas planned to deploy during the Expedition

Operation:Antennas: Dipoles

Selected Value: 0

Number of dipole antennas planned

Operation:Antennas: Verticals

Selected Value: 0

Number of vertical antennas planned

Operation: Experience: Team Members

Please list the team members and their Expedition experience

QSL Information: QSL Options

QSL Information: LoTW

When will the Expedition logs be uploaded to LoTW?

Logo: Will the KCDX Club logo be printed on the QSL cards? *

Yes
No
Other

Logo: Will the KCDX Club logo be displayed on the Expedition's web site? *

Yes
No
Other

Logo: If "Other" was selected above, please explain: