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Membership
Application
Date:
Country/State
Represented
National
Sailing Authority affiliation or association
Name
of blind sailing organization
Contact
Person
Mailing
Address
E
mail address
Telephone:
Fax:
Membership
fee $50.00 US check enclosed
or Master Card/Visa
Master
Card/Visa #
Expiration
Date
Name
as it appears on credit card
Signature
Address
of Cardholder (as it appears on your bill)
Telephone
# of cardholder
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