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QCPB Club Membership Application
Please complete this form and then mail your payment to:
QCPC, Attn: Membership, 4620 37th Ave, Rock Island, IL 61201
Make checks payable to: Quad Cities Pickleball Club
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Gender
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Applicants Birthdate
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Membership Choice:
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1 year- $15
3 year- $40
5 year- $65
Lifetime- $180 (Lifetime will receive a free QCPC Shirt)
Today's Date:
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Name: (First,Last)
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Address
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Phone:
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Email:
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Emergency Contact: (Name & Number)
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