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Paskack Junior Woman's Club Membership Form
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* Indicates required question
Last Name, First Name
*
Your answer
Email Address
*
Your answer
Email Address Confirmation
*
Your answer
Phone Number (Cell)(555-555-5555)
*
Your answer
Home Address
*
Your answer
I am interested
*
in being a first time member.
in continuing my membership.
in ending my membership.
I agree to pay the once a year membership fee of $50.
*
Yes, I will pay via PayPal. Please send me an invoice to the email I've provided.
Yes, I will pay via cash or check.
Not applicable.
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