Membership ApplicationLAST ________________________ FIRST________________________ MI___ Address___________________________________________________________ City_______________________________ STATE___________ Zip___________ Phone: ________________ Email: ____________________________ Date of Birth Mo._____ Day_______ Year ________ Age___________ Sex _______
--------------------------------------------------------------------------------------------- Return with $10.00 (checks payable to Marshfield Road Runners) annual membership dues to: John Sousa
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