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Beginning Date
First Name
Last Name
Status:
Telephone 1
Telephone 2
Street Address
City
State/Province
Zip/Postal Code
E-mail 1
Web Site
Last Payment/Donation Date
Check # or Merch Desc Amount/Value $
Notes
Omit member from Distribution List given to Society Members
Omit member from Distribution List given to Art Suppliers
Member will serve as a VOLUNTEER doing:
Member wishes to receive PRINTED COPY of Newsletter.