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 Club Station Membership Renewal Application

 Ten-Ten International Net, Inc.



This is the first step of a two step process, this form is used to verify your membership information once this form is complete you will be directed to the shopping cart to complete the process. Please note Ten-Ten uses the PayPay Express checkout system. This will allow you to use either a PayPal account or a credit Card if you do not have a PayPal account. Credit cards accepted are VISA, MasterCard, Discover Card, or  American Express Card. Just click on the PayPal image in the cart when you get ready to check out. To avoid confusion unless you plan to pay by check or money order do not use the "go to checkout" link,just click on the PayPal image.
 You can also use a money order or personal check to complete your purchase. You will receive your renewed membership card via postal mail. Thank you for your support.

All Fields Required unless otherwise noted Please Note that Club Stations may not apply for life membership
Name:  Club StationCallsign:  
 Club Station Ten-Ten#:
Address:  Address Information is for Ten-Ten News mailing and database.
City: State or Country:
Postal/Zip Code: Email Address: for contact
Trustee Call Sign: Trustee 10-10#:   
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 10/28/2011
Copyright © Ten-Ten International Net, Inc. 2011