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First Name:_______________ Last
Name:_____________________________
Are/ Were you a VAUS member
Yes/No_______
Street
Address:___________________________________________________
City:_________________State/
Province:___ Zip / Postal Code:____________
Company
Name:_________________________Title:____________________________
Web
http://______________________Email:_________________________
Phone:
________________Fax:______________Mobile___________________
Membership
Fees (Annual) Individual $40.00, Corporate$100.00,
Student $10.00
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