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Name: ___Tahira Lewis_______________________________________

Address: __28 Dellwood Dr. Fairborn, Oh 45324_______________________________________

_________________________________________________

_________________________________________________

Phone number: __937-751-6914_______________________

Email address: _lewis.tahira@gmail.com__________________________________

Initial each of the following:

_TL_____ I have read and agree to abide by the Dayton Diode Charter.

__TL____ I have read and agree to abide by the Membership Agreement.

__TL____ I have signed the Liability Waiver.


Applicant Signature: ____Tahira Lewis _______________________________ Date: __4/11/2022__________



Officer Signature: _______________________________________ Date: ____________


Licensed under Attribution-Noncommercial-Share Alike 3.0 Unported based on the Hive 13 Membership Application


Consensed on by Dayton Diode membership on Nov 2, 2010.

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