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Family Membership Application Ten-Ten International Net, Inc.



Once this form is completed it will be sent to the Data Manager for processing, he will in turn send you the link to the secure shopping cart to complete you transaction.

All Fields Required unless otherwise noted
Name: Callsign:
Address: Year of Birth :
City: State or Country:
Postal/Zip Code: Email Address:
Family Membership requires that a regular paid (Primary) member resides in the same household.
Primary Family Member Call Sign:
Primary Family Member 10-10:   Required for Family Membership
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):
For the Operator's Name in the form Below, please enter the one they used on the air during the contact. Do not use the one found in online services.
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)
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 Can Correspondence with 10-10 International Net, Inc be done via your email address? YES NO

Updated 1/15/2015
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