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Please fill out the following
information and press the SEND FORM button
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Family Single Student |
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Name |
Last Name |
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First Name |
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Middle Name |
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Spouse's Name |
(for family membership) |
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Contact Information |
Address Line 1 |
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Address Line 2 |
(optional) |
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City |
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State |
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Zip |
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Home Phone |
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Office Phone |
(optional) |
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Payment |
Membership rates are: $30/yr-family, $20/yr-Single and FREE for students. Please send your membership fee check to: Postal Address: PRAGATI INC., 8107 Germantown Ave, Philadelphia, PA 19118 |
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