Welcome to 10-10 International

DX COUNTRIES AWARD APPLICATION

Please print your Name:                                                                                  Call:                                                   

Address:                                                                                                           Ten-Ten #:                                        

City:                                                                                          State or Country:                                                       

Postal Zip Code:                                              E-mail Address:                                                                                


BASIC OR ENDORSEMENT APPLYING FOR (CIRCLE ONE) BASIC 25 (OR)


                35          45          55          65          75          80          85          90          95          100

                105        110        115        120        125        130        135        140        145        150

                155        160        165        170        175        180        185        190        195        200

                205        210        215        220        225        230        235        240        245        250

                255        260        265        270        275        280        285        290        295        300

I VERIFY, BY MY SIGNATURE, THAT I HAVE MADE THE ENCLOSED CONTACTS IN ACCORDANCE WITH THE RULES OF THE TEN-TEN INTERNATIONAL DX COUNTRIES AWARD PROGRAM


SIGNATURE_______________________________________ DATE____________________



(Please attach proof of paid dues)

Send application to:
Mike Davidson, N5MT
3518 Bellfontaine
Houston, TX 77025-1310

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