EmailMe Form - NCDXF Youth Grant Application

PLEASE FILL OUT THIS FORM COMPLETELY AND THEN CLICK THE "SUBMIT APPLICATION" BUTTON. A separate Application is required for each youth applicant (maximum of three).

DXpedition call sign (if known): *

Proposed Destination(s): *

Dates of operation and duration (how many days - best estimate?): *

Name, call sign and contact information for the DXpedition Leader: *

Applicant's call sign: *

Name *

Age: *

Mailing Address: *

Street Address City State / Province / Region Postal / Zip Code

Telephone #:

### - ### - ####

Email address: *

What year were you first licensed? *

What class of license do you hold? *

Have you been on other DXpeditions? If “yes” please provide details:

Describe other operating experience that you believe prepares you for this DXpedition:

What grant amount, in U.S. Dollars are you requesting from the NCDXF?

Please provide details supporting the requested amount as follows:

Airline Fares

Baggage Fees:

Other transportation costs (please describe them in detail):

Are you expected to contribute the same share of expenses as the other DXpedition team members? If “yes” what is that amount?

Any other anticipated expenses?

If you are under the age of 18, who will be the adult accompanying you on the DXpedition?

In applying for a grant from the NCDXF, you agree to abide by the following Terms and Conditions:

1. The NCDXF logo (available on the NCDXF website) will be prominently displayed on the QSL cards.

2. Applicant needs to confirm that supporting documentation exists (licenses, landing permission, etc.) and that it will be made available to NCDXF if requested.

3. You, along with any other youth operators, will provide an article for the NCDXF newsletter and at least three sample QSL cards within 90 days of concluding the DXpedition.

4. The DXpedition is required to upload all QSOs to the ARRL Logbook of the World (LOTW) no later than 12 months after the date of contact.

5. NCDXF shall have no responsibility for and no liability arising from any activity that results from the funding of this application. You agree to indemnify and hold harmless the NCDXF for any claims arising from such activity.

On pressing the 'Submit Application' button below, you are indicating that you have read and accept the guidelines above.

You should receive an email acknowledgement of your application on submission.