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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 $55.00. (a dollar for each of the fifty-five men that attended the Constitutional Convention in Philadelphia in 1787).
Return this form with your tax deductible dues payable to the National Council of Censors.
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