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Please send a receipt: Yes __ No __
Please indicate your chapter selection: L.A.___ Orange Cty. ___ San Diego ___
*For organization memberships, please indicate names of up to four additional members:
Name: _____________________________ Email & Work # : _______ _______________
Name: _____________________________ Email & Work # : _______ _______________
Name: _____________________________ Email & Work # : _______ _______________
Name: _____________________________ Email & Work # : _______ _______________
Signed: __________________________________ Date: ____________________________
If you have any friends, co-workers, clients, or other contacts that might be interested in WEC, please
fill out the following information for us, and we will add them to our mailing list.
Name: _________________________ Company: ___________________________________
Address: ________________________________City: _____________________ Zip: _______
Email & Work # : _______ __________ ____
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