Please print your Name: _______________________    Call:  ____________________

Address: ___________________________________     Ten-Ten #: _______________

City: ______________________________________      State or Country: __________

Postal Zip Code: ______________________    E-mail Address: __________________

Rules:

·        Applicants must work a 10-10 member in each of the 50 states. Cost is $2.00 USA and $3.00 for DX. Please include your E-mail address, if you have one.

• Detailed data submitted should be listed alphabetically by state. Each contact must be on a separate line.

• Worked All States QSO's are allowed only from within a 50 mile radius of the applicant's home QTH.

• QSL confirmation IS required. On all QSL cards, or photocopies, the call sign of both stations must be clearly legible. Photocopies will not be returned unless enough postage is sent to cover mailing cost. Please send enough return postage if you send cards.

• 10-10 award general rules and requirements are applicable.

Effective -August 24,2000 

Mail to:

 Worked All States Manager