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Club VIBES Membership Application
Club VIBES Applicant Profile
Applicant's Legal Name: *
Preferred Name: *
Gender *
Applicant's Birth Date *
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Applicant's Address: *
Applicant's Phone Number: *
Applicant's Email address: *
Level of education: *
Level of Vision: *
How did you hear about Club VIBES?
Why are you interested in joining Club VIBES and what are some of your goals?
Would you be interested in joining auxiliary meetings (ex. Book club, fitness)?
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Applicant's Signature
PARENT CONTACT INFORMATION
Minor data: if under the age of 18
Parent(s)/Legal Guardian(s) name:
Parents cell phone
Home phone
Parent(s)/Legal Guardian(s) email:
Parent(s)/Legal Guardian(s) signature
Date signed *
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Date application approved (office use only)
MM
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