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First Name
Last Name
Street address
City
State/Region
Email
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Phone Number
Date of birth
Gender
Marital status
Name of Associated Current Member
Locker Name (Exactly how it would appear on locker)
Facebook Username
Instagram Username
Hobbies and/or Interest
Favorite Cigars
Annual Membership - $800 (Discounted rate)
Monthly Membership Payment - $85 per monthly (recurring method of payment required)
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