Call: ___________ Name: ____________________________ Address: __________________________ City, State, Zip: ____________________ Country: __________________________ Email: ____________________________

Please check the box next to your contribution amount: US $5,000 Emperor Level US $1,000 King Level US $500 Rockhopper Level US $250 Magellanic Level US $100 Gentoo Level US $50 Adelie Level Other Amount   Chinstrap Level

If you are sending a check, please make it payable to "DX Expeditions, LLC"

Bob Allphin, K4UEE
4235 Blackland Dr
Marietta, GA 30067-4705

NOTE: () Donations of $50 or above can be made to NCDXF and obtain Tax Deductability (consult your advisor).  Make the check payable to NCDXF and on the check memo line write: "directed contribution-Peter I Expedition"

Mail the NCDXF check to:

Bruce Butler, W6OSP
4220 Chardonnay Court
Napa, CA 94558