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
