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Application for Membership into Michiana Education and Arts Club. Completing this application does not guarantee admission into Michiana Education and Arts Club, but it is the first step into being considered for membership.
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Date
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First Name
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Last Name
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Mailing Address
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City
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State
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Zip
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Email Address
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Phone number (for SMS)
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Are you 18 years of age or older?
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By signing below, I certify all information is true and correct to the best of my knowledge (Sign / Date) If electronic, you will be asked to sign at induction meeting
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