New York Metro Chip Club
Membership Application
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Name:       ___________________________________________

Address:   ___________________________________________

City/State: ___________________________________________

Zip:           ________ Phone: _____________________________

E-mail:      ___________________________________________
 

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Send this form and a check (made out to Charles Kaplan) in the
amount of $5.00 for a one year membership to:

New York Metro Chip Club
Charles Kaplan
11 Calais Court
Rockville Centre, NY 11570

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