P.O.A Membership Form
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Name(s) _____________________________________________________ |
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Address _____________________________________________________ |
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Village/Villa __________________________________________________ |
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County ___________________________ Zip _________________ |
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Phone __________________________ |
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E-Mail _________________________________________ |
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New _______ Renewal ___________ Date _______________ |
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Annual Dues: $6.00 __________ Extra Donation $__________ |
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TOTAL ENCLOSED $ ______________ |
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Fill out the form and return with
your membership dues to : |