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C.H.I.P. Membership Form

Become a Member Now!

Coalition of Hispanic/Latino Issues and Progress
P.O. Box 614 Lorain, OH 44052

Membership dues for 2010 are now due ($25.00): Please print, complete and bring this form to the next CHIP meeting or mail it to the above address. We need your support

Name_________________________________________________
Address_______________________________________________
_____________________________________________________
Phone number: Home______________ Work_________________
Check $_________
Cash $__________

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