Tripoli Southern Minnesota
Members Application Form 2005
Tripoli Southern Minnesota
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NAME:_____________________________________________________
Tripoli #________ OR NAR#________
Current Level of certification?_______
Age:_____
Address:_____________________________________________________
City:_______________________________________________
State:__________________ Zip:________
Home Phone:______________
e-mail:_____________________________________________________
Dues:
$40.00 per year
Effective January 1 to December 31
Individual member includes family
Other: $10.00 per launch
____Not joining today, please keep me on your mailing list for notices by e-mail!
Please make checks payable to TSM and send with this form to the following address:
Contact Tripoli Southern Minnesota Prefect