Family Membership Renewal Application

Ten-Ten International Net, Inc.


This is the first step of a two step process, this form is used to verify your membership information once this form is complete you will be directed to the shopping cart to complete the process. Please note Ten-Ten uses the PayPay Express checkout system. This will allow you to use either a PayPal account or a credit Card if you do not have an account. Credit cards accepted are VISA, MasterCard, Discover Card, or American Express Card. Just click on the PayPal image when you are ready to checkout. To avoid confusion unless you plan to pay by check or money order do not use the "go to checkout" link,just click on the PayPal image.
You can also use a money order or personal check to complete your purchase. You will receive you renewed membership card via postal mail. Thank you for your support.
This section is for family member information. All fields are required unless otherwise noted.
Name: Family Member Callsign:
Address: Year of Birth: Ten-Ten:
City: State or Country:
Postal/Zip Code: Email Address:
Family membership requires that a paid regular (Primary) member resides in the same household.
Primary Family Member Call Sign: Primary Family Member 10-10#: Required for Family Membership
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.
I certify that I meet the membership requirements of 10-10 (typing your name on this form is the equivalent to your personal signature):

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

Updated 10/28/2011
Copyright © Ten-Ten International Net, Inc. 2011