MembershipCards_S

J. 7

NamaLizabaqer; EoerL C-le,; f Business ยท

~No.

Residence Address,____________ Other Members Single._____ Married_____ Children____ of Household____ Membet of "hat Clm1ch ~ # (! d by kite. t: fro 111 /.s T 7ks CA I( n--6 - Othe1 Membets of Family tl._1

Member of Committee

Date___________

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