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CLUB FULL NAME: |
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| CLUB ID# | |
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PRESIDENT: |
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| HRC MEMBERSHIP # | |
| Address | |
| City | |
| State/Province | |
| Zip/Postal Code | |
| Phone | |
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VICE PRESIDENT: |
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| HRC MEMBERSHIP # | |
| Address | |
| City | |
| State/Province | |
| Zip/Postal Code | |
| Phone | |
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TREASURER: |
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| HRC MEMBERSHIP # | |
| Address | |
| City | |
| State/Province | |
| Zip/Postal Code | |
| Phone | |
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SECRETARY: |
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| HRC MEMBERSHIP # | |
| Address | |
| City | |
| State/Province | |
| Zip/Postal Code | |
| Phone | |
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CORRESPONDING OFFICER IF DIFFERENT THAN SECRETARY |
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CORRESPONDENT: |
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| HRC MEMBERSHIP # | |
| Address | |
| City | |
| State/Province | |
| Zip/Postal Code | |
| Phone | |
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Club's WEB SITE: |
Please hit the submit button only once, after carefully checking the information in each box. You will receive a confirmation when the form is sent. Thank you.
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