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Please print out this form and mail to Suzanne Graboski as shown below
USMMA Mid-Atlantic Parent’s Association 2007-2008 Registration Midshipman’s Name: ______________________ _________ Class of: _______ Company: ___________ Academy Mail Box : ___________ Birthday: ___________ Sports/Club Activities: ______________________________________________ Father’s Name: _________________________________ Mother’s Name: ________________________________ Parent’s Mailing Address: ___________________________________ ___________________________________ ___________________________________ Parent’s Home Phone: _______ - ________ - ________ Father’s Daytime Phone: _______ - ________ - _________ Father’s Cell Phone: _______ - ________ - _________ Mother’s Daytime Phone: _______ - ________ - _________ Mother’s Cell Phone: _______ - ________ - _________ Parent’s Primary Email: ____________________________________________ Parent’s Alternate Email: ___________________________________________
Annual Dues: $25 per family Make Checks Payable to: USMMA Mid-Atlantic Parent’s Association Please send to: Suzanne Graboski, President 3950 Bluewater Drive, Moneta VA 24121 e-mail: kpmom2011@yahoo.com Phone: 540-288-4555 |
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Send mail to kpmom2011@yahoo.com with
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