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Portobello Community Inc. Membership Application |
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Name: |
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Address: |
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Telephone: |
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Email: |
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Gender: |
Male o Female o |
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Membership Category/s: |
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resident o work in Portobello o participate in the Portobello Community |
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I hereby apply for membership of Portobello Community Incorporated and agree to abide by the Rules of the Society |
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Signature |
Date |
Return to:
Portobello Community Inc.
C/- 6
Portobello
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Official use only: Date admitted: Subscription: Free in 2011 |