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MEMBER'S LIFE
MEMBER NUMBER ____________________
MEMBER NAME: _____________________________________________________________________________
ADDRESS:
_________________________________________________________________________________
CITY :
__________________________________________STATE:_____________
ZIP_____________________
FROM DUGOUT _________________________ TO DUGOUT 570 SEASIDE
MEMBER'S SIGNATURE
_______________________________________________________________________
SIGNATURE OF RECEIVING DUGOUT'S
R.E.G._____________________________________________________
After brother has been accepted by the new Dugout, send this
form to Imperial Headquarters at:
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