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Membership Application

Please fill in this form for our directory and data base.  

After sumitting your form, please remit a check for $75 to:
Christ Child Society of Northern Michigan, P.O. Box 132, Harbor Springs, MI  49749

Contact information
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First Name
Last Name


First Name
Last Name

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State/Province
ZIP/Postal Code

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code


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