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Please sign me up as a new member of Rose City Roamers:

Name___________________________________________________

Address_________________________________________________

City________________________ State___________ Zip__________

Home Phone_____________________________________________

Work Phone_____________________________________________

Email address____________________________________________

Other family members to be included in the membership:

________________________________________________________

Mail this form with a $6.00 check to:

Noreen Kirk
6025 N. Villard
Portland, Oregon 97217

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