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755 Highland Oaks Drive, Ste 202 Winston-Salem, NC 27103Phone (336) 9974599 www.ascendeye.comNEW PATIENT REGISTRATION Referred by:___Family doctor:___ Name.(Last, First)___ Date of birth___ Home Address___

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Individuals who are applying for a new AEC (Asean Economic Community) membership.

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AEC Form - New is a form used to report annual energy consumption.

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