Southern Tier Zoological Society                      Board of Directors                                    Application for Membership
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Applicant's Name *
What is your home mailing address *
City (Broome County).        If you live outside of Broome County, please skip to the next section "Other City".
Other City (outside of Broome County)
State *
Zip Code *
What is a telephone number where you can be contacted? *
Is this a cell or a landline? *
What is your personal email address (if applicable)?
I you have both a personal email and a work email, which would you prefer that we use to communicate with you? *
Work email address
Current Working Status  --  Are you retired? *
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