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MEMBERSHIP
APPLICATION
January 1, 2015 to December 31, 2015
Name:
____________________________________________________________________
Street Address:_____________________________City/Town________________________
County ____________________________State__________________
Zip______________
Home Phone__________________________Bus. Phone____________________________
Wrestling Affiliation If
Any____________________________________________________
E-mail
Address______________________________________________________________
Membership is $25.00 Per Year. Make Checks Payable to Long
Island Wrestling Association, Inc.
Additional contributions beyond our $25.00
membership will be greatly appreciated!
Mail Your Check & Completed Membership Application to:
Long Island
Wrestling Association, Inc.
117 Dale Dr
Oakdale, New York 11769
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