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P.P.H.S. MEMBERSHIP FORM
Name:
Address:
City/State:
Home Phone:		Bus. Phone:
Email:
[ ] Individual, $20 [ ] Family, $35 [ ] Business, $75 [ ] Patron, $100
[ ] Life Membership, $500 [ ] Student $15 [ ]Sponsor $1,000 Contribution $________

Dues are from July 1st to June 30th
Dues and Contributions are Tax Deductible

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P.P.H.S. MEMBERSHIP FORM