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ROAD/ROAD MEMBERSHIP FORMED NAME: Make a SelectionMembership Dues $20 Pay to: Inland Empire United Way & Mail to P.O. Box 130027 Big Bear Lake, CA 92315PLEASE PRINT AND PROVIDE TWO CONTACT NAMES Organization

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Please print and provide is a request for individuals or entities to print a specific document and provide necessary information as required by regulatory or administrative processes.

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The information that must be reported typically includes personal details, financial data, and any other specifics outlined in the form's instructions.