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CHRISTMAS CLINIC APPLICATION FORM Saturday & Sunday, December 6 & 7, 2014 NAME: DATE: STREET: CITY: STATE: ZIP: AGE: HOME PHONE: DATE of BIRTH: SEX: HEIGHT: WEIGHT: FEE $50.00 SECOND FAMILY MEMBER
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Christmas clinic - american is a form that must be filed by certain individuals in the United States who have received medical treatment or services during the Christmas holiday season.
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