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 Life 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 Please Note that Club Stations may not apply for life membership
Name: Callsign:    Ten-Ten:
Address: Year of Birth :
City: State or Country:
Postal/Zip Code: Email Address:
Senior Life is 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):

Can Correspondence with 10-10 International Net, Inc be done via your email address? YES NO

Updated 01/01/2015
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