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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)

Send application to

Mike Davidson, N5MT
3518 Bellfontaine
Houston, TX 77025-1310