Scout Ten Ten Membership Application

Ten Ten Membership Application for Scouts under the age of 18

Ten-Ten International Net, Inc.

Once this form is completed it will be sent to the Data Manager for processing, you will be asked to validate your scout membership. Once your application is approved the Data Manager will contact you with your Ten Ten membership information. He also will contact the Scout Awards Manager. The Awards Manager will contact you with your Award information.

All Fields Required unless otherwise noted

Name:	Callsign:
Address:	Year of Birth:
City:	State or Country:
Postal/Zip Code:	Email Address:
Scout Membership Number:	Scout Council:

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.

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

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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Ten Ten Membership Application for Scouts under the age of 18

Ten-Ten International Net, Inc.

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.

10-10 NUMBER

CALL SIGN

OPERATOR'S NAME

DATE OF CONTACT

QTH (State, Province, Country)