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8 9 8 7 E. T an n q u e Ve r d e Rd. 30 9 9 0 8 T u c s o n, AZ 85 74 9 77 5 7 7 2 8 7 2 1 NOMINATION FORM FOR CABLE TV PIONEER MEMBERSHIPPart A. Candidate Information Full Name: Spouse: Firm Name:
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