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Sumter County Seminole Club Membership Application

P. O. Box 425

Bushnell, Fl.  33513

 

Name_____________________________________________ 

Phone_______________________________

Address___________________________________________

 

Family Membership $20.00__________

Individual Membership $15.00_________

Sustaining Membership $100.00_________ (If a business please submit a business card)

Family Members Names and Birthdates

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

 

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