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COMPLETE AND RETURN THIS FORM TO: Youth Basketball of America 10325 Orange wood Blvd Orlando, FL 32821 Phone: 4073639262 SECTION I TO BE COMPLETED BY PARENT×CLAIMANT (required) 52week benefit period

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6. If necessary, attach any supporting documents that may be required along with the form.
7. Finally, carefully review the instructions provided on how to return the completed form. This may involve mailing it to a specific address, submitting it online, or hand-delivering it to a designated location.

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