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Address: _________________________________________
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Phone number: _________________________
Email address: ___________________________________
Initial each of the following:
______ I have read and agree to abide by the Dayton Diode Charter.
______ I have read and agree to abide by the Membership Agreement.
______ I have signed the Liability Waiver.
Applicant Signature: ___________________________________ Date: ____________
Officer Signature: _______________________________________ Date: ____________
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Consensed on by Dayton Diode membership on Nov 2, 2010.