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-------------------------- Click Here for PDF Format of Membership Form Membership Form Name__________________________ Age _____ Birthdate_____/____/______ Name__________________________ Age _____ Birthdate_____/____/______ Name__________________________ Age _____ Birthdate_____/____/______ Name__________________________ Age _____ Birthdate_____/____/______ (List only those family members who attend CCRC events as particpants or helpers. If more than four members of your family are CCRc members, please write their name and ages on a separate sheet) Address__________________________ City ___________________ State _______ Zip _______ Home Phone ______________________ Work Phone_______________________ Annual Dues ________ Person $10 ________ Family/Couple $20 ____ New Membership or _____Renewal
Return to: John Martin, 4502 NE 142nd St, Vancouver WA 98686 360-574-8087
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