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Name: ______________________________________________ Address: _____________________________________________ City: _________________ State: ______ Zip: ___________ Home Phone: ___________ Cell Phone:_______________ e-mail:_______________________________________________ Home Church: ________________________________________
Send this form along with $20 for adult or $5 for students to: F.O.C.A.S. c/o James Shelton 338 Wildflower Way Cadiz, Kentucky 42211 |