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MEMBERSHIP FORM 2013

 

SINGLE   $5.00            _____________                                  FAMILY$15.00 ____________

 

Name______________________________________________________________

 

Address____________________________________________________________

 

City_____________________________________ State______________________

 

Zip_____________________________  Phone _____________________________

 

Email address: ____________________________________________________

 

Additional members at the above address:

 

___________________________________________________ _____ adult _____ child

 

 

___________________________________________________ _____ adult _____ child

 

 

___________________________________________________ _____ adult _____ child

 

 

____________________________________________________ _____ adult _____ child

 

Mail membership form and check (written out to Galesburg Boots and Saddles Club) to:

 

Galesburg Boots and Saddle Club

939 West Knox Rd.

Galesburg, IL  61448

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