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Southwest
Division |
Registration for Monthly Newsletter To receive the monthly newsletter via e-mail and occasionally mailings regarding activities within our organization, please fill in the blanks. |
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| Name: (Please Print):____________________________________________________________________ | |
| Name Of Affiliation:____________________________________________________________________ | |
| E-Mail Address:________________________________________________________________________ | |
| Mailing Adress:_________________________________________________________________________ | |
| City:_______________________________________ | State:_____________________________________ |
| Zip + 4 if you know it):___________________________________________ | |
| Telephone (Including Area Code): | Home: ( )_______________________ |
| Business: ( )_____________________ | |
| Fax: ( ) ______________________ | |
To receive certification
credit hours and the monthly newsletter you must be a member |
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| Membership Type: | |
| _____Inspector: | C.E.S.I. #____________________ |
| _____Associate | OCIlB #______________________ |
| _____Retired | Kentucky______________________ |
*Print this form and mail to the
Southwest Division
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