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National Council of Censors
Membership Application
(402) 991-8124
Date: ____________Memberships Status: New_____Renewal______
Name:__________________________________________________
(Title) (First) (Last)
Address:________________________________________________
City:______________________State:______Zip:________________
Phone:____________________E-Mail:________________________
Enclosed are my annual dues of $13.00 dollars (one dollar for each individual state in the union in 1787 when the Constitution was adopted.)
Return this form with your tax deductible dues payable to the National Council of Censors.
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