GUAM CLUB OF THE STATE OF WASHINGTON
MEMBERSHIP APPLICATION


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LAST NAME:                                 FIRST:                                  MI:                               DOB: (MO/DAY/YR)

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LAST NAME:(SPOUSE)             FIRST:                                  MI:                               DOB: (MO/DAY/YR)

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STREET ADDRESS/P.O. BOX                                                                                       HOME OF RECORD
                                                                                                                                                (VILLAGE/CITY)

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CITY:                                                       STATE:                               ZIP:                          HOME PHONE

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                                                                                                                                                WORK PHONE

***************** CHILDREN/DEPENDENT INFORMATION ****************

                                                                                                                                              GRADUATION
  NAME(S)                                                   DATE OF BIRTH                                               YEAR
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SPECIAL NOTE(S):
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