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Get Pass Membership Form - Middlebury College

Evel requested (check one): Patron $100 Advocate $500 Partner $1,000 Producer $2,500+ Scholar (Middlebury students only. No fee.) Please also credit my Spouse Partner Spouse/Partner Name: Payment Information Membership Amount: $ Payment type: Check Credit Card Name as it appears on card: Credit Card Number: Expiration MM/YYYY: CVN Number: Billing Address Street Address 1: Street Address 2: City: State: Postal Code: Country: Gifts made to Middlebury Co.

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