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Get FALSS REGISTRATION FORM - Falss

H COMPLETE & MAIL THIS FORM POSTMARKED BY DECEMBER 16, 2011 TO: MICHELLE A. COOPER, 3QMM CHAIR c/o 702 S. MAGNOLIA AVENUE, SUITE 2 OCALA, FL 34471 Hotel reservations are to be made directly with: Name Badge Info-First/Nickname Address City State Zip Local Chapter Telephone No.: ( ).

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