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D. Number Membership Category Payment Plan/ Scholarship Fee Name on card Card please print clearly Security Code Expiration Date I the undersigned agree to abide by the rules and regulations of the Central Queens YM YWHA and affirm that all the information given above is accurate. I understand that certain programs at the Y may involve strenuous physical activity that an applicant is responsible for being physically fit for such participation and the Y is not responsible for injury or other...
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