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Join the
S E N I O R P A T T E R N A S S O C I
A T I O N
Right click on this page and print for a copy of the form.
Membership Application |
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| Name______________________________________________ Birthdate____________ |
| Address_______________________________________________________________ |
| City,
State,Zip___________________________________________________________ |
| AMA # _____________________ |
| PHONE ___________________________________ EMAIL
__________________________________ |
| General Information |
| All members must have current AMA License.
Membership dues - $20.00 Calendar year.
Checks payable to: Senior Pattern Association
Mail to:
Mike Robinson
2006 Brookhaven Circle
Dalton, GA. 30720
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