TEN-TEN INTERNATIONAL NET, INC.

DX COUNTRIES AWARD APPLICATION

CALL__________________________ 10-10#___________________________

NAME______________________________________

MAILING ADDRESS_______________________________________________________

CITY, STATE, COUNTRY, ZIP________________________________________________

____________________________________________________________________________
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)

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