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AUXILIARY CLOWN REQUEST Mail To Grand Hospital Chairman Grand Auxiliary Name Number Date Supreme Mama/Papa Clown Please issue Supreme Clown Cards and pins to the following Name Dates of Three 3 Qualifying Visits Made Between August 1 2016 and July 31 2017 Please print clearly or type Note MOC or Jr. If applicable I certify that the above have made three 3 Hospital Visitations as a Clown and these visits have been reported on an MOCA Auxiliary Hospital Report Form. Auxiliary Hospital Chairman...
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