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Get Valley Metro Bus Pass

De ) Phone Number with Area Code Date of Birth (month/day/year) Email Address Check only one: o Youth (Ages 6 through 18) o Senior (Ages 65 and older) Check the appropriate box: o New card - $5.00 o Lost card - $2.50 o Medicare Cardholder o Persons with a Disability SECTION 2 TERMS AND CONDITIONS (TO BE SIGNED BY APPLICANT) I certify to the best of my knowledge that the information on this application is true and correct. I understand that prov.

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