MEMBERSHIP FORM
Please fill out completely: Please Print
Name:
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Address:
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City:
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State:
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Zip Code:
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Phone:
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Email:
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Birthdate:
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T-Shirt Size: Circle
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Please enclose $35.00 for 2010 membership. Mail to: FSA 124 5th Avenue
North, Jacksonville Beach, FL 32250
For member benefits or to join on-line using a
credit card please visit: www.floridasurfing.org
