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Name______________________________________________ |
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Address________________City________State________________ |
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Zip____________ |
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Telehone_____________Evening:________Cell:______________ |
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Supporting Member:_________Performing member__________ |
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Instruments:________________Vocalist:____________________ |
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Bamd :eader"______________Name of Band:_______________ |
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No. in Band:__________ |
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Date of Birth: You"_____________Your Spouse:_____________ |
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Other Interest:_________________Volunteer Work____________ |
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Fee Paid: Single:($15) Couple: ($20)______________ |
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Date: ___________ |
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email:______________ |
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Board Approval:________________ |
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| Send Application to: WSMSS P.O. Box 644 Shattuck, OK. 73858 |
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