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VILLAGE OF NEW MINES PROGRAM REGISTRATION FORM PLEASE COMPLETE ALL APPLICABLE SECTIONS PLEASE PRINT NAME: ADDRESS: EMAIL ADDRESS: HOME PHONE #: WORK PHONE #: CELL PHONE #: HEALTH CARD #: PHYSICIANS
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Please complete all applicable refers to filling out all necessary sections or fields that are relevant to your specific situation or case.
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kristamnewminas indemnify undersigned DEBIT REGISTRATIONS APPLICABLE arising MINAS aforementioned participant Tel PAYABLE REGISTERING PHYSICIANS GUARDIANS CHEQUES deemed recordings

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