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Entry Level Life Membership Application

Ten-Ten International Net, Inc.


This form is for those Amateurs that desire to become Life Members at the time of initial membership. This is a two step process. First you must complete this form to apply for membership. Once this form is completed it will be sent to the Data Manager for processing, he will in turn send you a special number to use in the completion of the life membership purchase on the secure shopping cart. After that transaction is completed the data manager will send your personal membership information including your own Ten - Ten number.
All Fields Required unless otherwise noted.
Club Stations or Family Memberships cannot apply for life membership

Name: Callsign:
Address: Year of Birth :
City: State or Country:
Postal/Zip Code: Email Address:
Please Note: As of November 8 2013 KC4TVZ is no longer a member of Ten-Ten please do not submit his information on this application or any awards.
 
10-10 NUMBER
CALL SIGN
OPERATOR'S NAME
DATE OF CONTACT
QTH (State, Province, Country)
1
2
3
4
5
6
7
8
9
10

Senior Life Membership available for members 65 or older Life Membership Type:
Normal Senior Electronic Delivery Option
NOTE: 10-10, NUMBER, CALL, NAME, MEMBERSHIP STATUS AND EMAIL ADDRESS IS MADE AVAILABLE TO ALL MEMBERS VIA A MEMBERSHIP ROSTER. ALL OTHER INFORMATION IS KEPT CONFIDENTIAL AND NOT DISCLOSED EXCEPT BY ORDER OF A LAWFUL COURT.
I certify that I meet the membership requirements of 10-10 (typing your name on this form is the equivalent to your personal signature):
 

Updated 01/15/2015
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