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The Cajun-Zydeco Connection of Huntsville, Alabama
2006 Membership Application

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Form cannot be submitted without this information.


Membership Status: New Member Renewal

Personal Information
     
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Last Name *
Address * Apt # 
City * State *  Zip Code * 
Home Phone *
Work Phone Ext
Email *
Occupation
Birthday (month/day)

Please do not publish my address, email, or phone number in the CZC directory.


Membership

CZC is a non-profit organization.
Membership costs are tax deductible for most people.
(Consult your tax advisor.)

Basic - $30
Supporting - $50
Patron - $100
Benefactor - > $100,    Amount


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