2017 RMHPA Membership Form
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First Name
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Last Name
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Address
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City
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State
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Zip
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Phone
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Email
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USHPA Number
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Expiration Date
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Hang Gliding Rating
Paragliding Rating
Mini Wing Rating
Tandem Rating
Emergency Contact #1 Name
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Emergency Contact #1 Phone
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Emergency Contact #2 Name
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Emergency Contact #2 Phone
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Colorado CORSAR Card Number
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Colorado CORSAR Expiration Date
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