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Circolo Italo-Americano Corenese Membership Application
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Email
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First Name
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Last name
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Place of Birth
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Birthdate
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Street Address
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City
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State
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Zip Code
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Email Address
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Phone Number
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Profession/Occupation
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Sponsor (Include Member Name)
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Membership Dues
Dues will be collected once your membership has been confirmed. Your $50 payment can be made directly to C.I.A.C. Treasurer, Fil Biagiotti, or through the club Venmo Account: @CIAC_Club.
A copy of your responses will be emailed to the address you provided.
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