REGION:____________ DATE: _________
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CLUB MAILING ADDRESS: Please give complete address |
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MEMBER TO CONTACT: |
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PHONE NUMBER: (HOME): ( ) - (BUSINESS): ( ) - |
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HEADCOACH: PHONE #: ( ) - |
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COACH’S ADDRESS: |
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NAME AND ADDRESS OF PRACTICE SITE:
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Name: |
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Address: |
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City, State, Zip: |
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Email Address: |
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COMMENTS TO STATE PRESIDENT FOR REVISIONS TO BYLAW, ETC:
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REGIONAL DIRECTOR NOMINATION: ____________________________