DVWFFA Name: _________________________________________________ Address: _______________________________________________ _______________________________________________ City: __________________________________________________ State: ________________ Zip: _____________________________ Phone: (Day) _________________ (Eve) ______________________ Fax: ______________________________ E-Mail: _________________________________________________
Note: The information on this form will be published in our member directory unless you inform us of your wishes to the contrary. Please omit or mark with an asterisk any item you wish to remain confidential. Please send this form along with your check for $30.00* to:
* Make check payable to DVWFFA |
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