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2nd VICE DISTRICT GOVERNOR-ELECT DATA FORM DISTRICT TYPE OR PRINT PLEASE DO NOT WRITE PLEASE COMPLETE ALL BLANKS This information will be used for the MD19 Roster Mailing Labels MAIL TO MD19 OFFICE P. O. BOX 66 BELLINGHAM WA 98227 FOLLOWING DISTRICT ELECTIONS NAME SPOUSE S NAME MAILING ADDRESS Street City State or Province Postal or Zip Code Your Residence Address will be used unless a different mailing address is given above. RESIDENCE ADDRESS Postal or Zip Code RES. PHONE FAX CELL PHONE...

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