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Join the MALC
After completing the form send payment to paypal@midatlanticleonbergers.com, send a check to Agi Hejja 3831 Broad Street Rd., Gum Spring, VA 23065, or wait for an invoice from us. Thank you!
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First Name:
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Last Name:
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Street Address
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City
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State:
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Zip:
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Membership Type
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Regular Individual ($10)
Regular Household ($10)
Associate Individual ($10)
Associate Household ($10)
Donation
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$10 - Rosette
$25 - Trophy
$35 - Rosette and Trophy
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Phone:
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Email:
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Sponsors (Two):
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Amanda Badillo
Agi Hejja
Eileen Pevarski
Matthew Townsend
Susan Townsend
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