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Girls Grass Roots Development Insurance Application CLUB NAME : CLUB ID NUMBER: CLUB SECRETARY : E mail Address: Tel No (H) (M) Total number of Teams: This insurance is ONLY for clubs who have teams

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The purpose of this form is to report wages paid to employees and taxes withheld to the IRS.

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The form must include the employee's name, address, Social Security number, wages, tips, and other compensation.

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