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Name:

Email:

Phone:

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List me as: (send one form for each designation)

Certified Clerk
Uncertified Clerk
Ring Clerk assist
Licensed Master Clerk
Unlicensed Master Clerk
Master Clerk assist
Entry Clerk
Steward

 

Region:

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Region I

 

Your location (closest metropolitan area, city & state)

 

How would you like clubs to contact you?

 

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