A1CC Application Form

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1)Your Callsign (MUST)


2)E-Mail Address (MUST)

(for confirm)

3)Full Name (MUST)


4)A1C Membership number (Please fill if you are a member of A1 Club


5)Select Category (MUST)
ORIGINAL
SPECIAL

6)Special Remarks
NIL QRP Single Band QRP+Single Band

7)Band(MHz) to be remarked (for Single Band applicants only)


8)Claimed Points (100, 200, 300, etc. 100points step, MUST)


9) Attach Log file (File size less than 5MB. MUST)


10)Message (free)


Before submit please confirm again. You'd better save above input data before sending. When you push "SUBMIT" button below, sending process starts immediately. Please wait until the "completed" message is shown.


In case you want to clear all data and re-write, please push following button.

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