10-10 WPX Awards Application

Please print your Name: 							 Call: 					

Address: 									 Ten-Ten #: 				

City: 								 State or Country: 					

Postal Zip Code: 				 E-mail Address: 							

Certificate applying for (Circle One)
Basic 100	200	300	400	500	
600	700	800	900	1000	
1100	1200	1300	1400	1500	
1600	1700	1800	1900	2000	

Rules:
•	All contacts must include call sign, name, QTH, and 10-10#. Cost is $2.00 USA and $3.00 for DX. Upgrades are SASE USA and $1.00 for DX. Please include your E-mail address, if you have one.
•	A call sign Prefix includes the right most number and all numbers and letters that precede it. For example, W6xxx, WB6xxx,
•	WN6xxx, 4X6xxx, etc. would all be a different Prefix.
•	Portable stations that sign with a suffix (/XX) may be used for the Prefix of the portable call. For example, W6xxx/HCl may be
•	used for the HCl prefix.
•	A certificate will be issued for the first l00 Prefixes. Upgrade gold bars will be issued for each additional 100 prefixes.
•	All applications must be submitted on the official forms available from the Award Manager or the 10-10 web site. A computer
•	printout with the same information may be submitted in lieu of the official application.
•	All call signs (entire call sign) must be in alphabetical order by Prefix.
•	QSL card confirmation is NOT required for the WPX award
•	10-10 award general rules and requirements are applicable.

DECLARATION:
By signing this application, I hereby certify that I have personally made contact with the Stations listed and the station listed gave me his 10-10 number during the contact. My logs Will be made available to the 10 -10 Prefix Manager if so requested.

I have enclosed a copy of my Membership Card, or address label from the latest copy of The 10-10 International News, showing my
status as a paid up member of Ten-Ten.

Signature: 								 Date: 				

Send Application To:
Ed Bryant, KM5FF, #50356
9001 Sunbow Ave SW
Albuquerque, NM 87121
E-mail to: elbble@gmail.com

© Copyright 2012 - 2018 10-10 International.

Page 1

10-10 WPX Awards Claim Worksheet

WPX #	Call Sign	Ten-Ten #	DX Country	Date	
1					
2					
3					
4					
5					
6					
7					
8					
9					
10					
11					
12					
13					
14					
15					
16					
17					
18					
19					
20					
21					
22					
23					
24					
25					

Page 2

10-10 WPX Awards Claim Worksheet

WPX #	Call Sign	Ten-Ten #	DX Country	Date	
26					
27					
28					
29					
30					
31					
32					
33					
34					
35					
36					
37					
38					
39					
40					
41					
42					
43					
44					
45					
46					
47					
48					
49					
50					

Page 3

10-10 WPX Awards Claim Worksheet

WPX #	Call Sign	Ten-Ten #	DX Country	Date	
51					
52					
53					
54					
55					
56					
57					
58					
59					
60					
61					
62					
63					
64					
65					
66					
67					
68					
69					
70					
71					
72					
73					
74					
75					

Page 4

10-10 WPX Awards Claim Worksheet

WPX #	Call Sign	Ten-Ten #	DX Country	Date	
76					
77					
78					
79					
80					
81					
82					
83					
84					
85					
86					
87					
88					
89					
90					
91					
92					
93					
94					
95					
96					
97					
98					
99					
100					

Page 5
© Copyright 2012 10-10 International.