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Rotary Club of Kernersville Membership Proposal Form Full Name City and State of Birth Date of Birth College s Attended Degree s attained Church Affiliation Not Required Other Civic Activities/Organizations Hobbies Name of Spouse Spouse s Date of Birth Date of Marriage Names Ages of Children Name of Business or Employer Position or Title Business Address Residence Address Preferred Address for Rotary Mail Business Phone Home Phone Cell Phone Fax Number E-mail Are you previously a Rotary...
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