Club Application

Club Membership Application

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 Paypal shopping cart to complete your transaction.

The By Laws state the following: The Trustee of a Club Station License with a unique government issued call sign may apply for a Club Station membership. Club Stations are not eligible for any other class of membership and can not vote in Ten-Ten affairs.

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NOTE: ALL MEMBERSHIP DATA IS PROTECTED BY THE PRIVACY ACT OF 1974 AND WHERE APPLICABLE THE GENERAL DATA PROTECTION REGULATION. THE ONLY DATA AVAILABLE THROUGH LOOK UP SOURCES IS CONSIDER NON PRIVATE.

Club Name* Call Sign*

Trustee Callsign Trustee Ten-Ten Email Address*

Mailing Address* Postal/Zip Code*

City* State or Country*

Contact List -- 10 Contacts with 1010 Members

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. When entering the station location, enter the 2 character US State abbreviation, or DX for all contacts outside of the US.

QSO Date* 10-10* Callsign* Name* US State or DX*

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):

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