2009 Membership Application
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NAME
____________________________________
ADDRESS
________________________________
CITY
______________________________________sT
STATE
_________________________________
PHONE
___________________________________
CELL
________________________________
E-MAIL
_______________________________
BIO INFORMATION
TYPE OF MEMBERSHIP (ENCLOSED CHECK FOR)
(1 YEAR)$_______ LIFETIME $______
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DONATION($_________)
I'm making a donation to help with______________________
i can serve the civic best by
List my name and phone number in your directory (yes)____(no)______