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Will NOT be processed.) Make check payable to: WMRRA Riders must sign the back of both pages. ( 3 signatures ) Return this application/medical form and payment to the address below. This application/medical form must be mailed/faxed and all signatures originals. Mail to: Date Rec d: Amt. Rec d: $ Credit Cash Check # WMRRA Registration c/o Membership Application PO Box 94323 Seattle, WA 98124 Fax: 1-206-374-2854 2011 Race # 2012 Race # Regist.

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