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* 1. Name

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* 2. Home Address

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* 3. Phone Number Cell/Home

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* 4. Email Address

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* 5. Date of Birth

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* 6. Occupation/Profession

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* 7. Spouse and Children's Names (Family Plan)

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* 8. Membership Type

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* 9. Name Badges (Optional) $14.00 ea.

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