Provider's Name: __________________________________________________
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City: _____________________________
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State: __________ Zip Code:____________
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Address: ________________________________________________________
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Phone Number: _________________________
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E-Mail: _________________________________________________________
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Gift Membership - Acknowledgement Card (Please let us know what to write on the gift card)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
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Gift Sender's Name (How do you want the card signed?)
______________________________________________________________________
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_____ Yes, I would like to find out more
information about DCFCCA volunteer
opportunities
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Toy Coop Location of choice:
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____ Eagan/Mendota Heights
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____ Inver Grove Heights
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Because the DCFCCA is not set up to take credit card transactions, please print the above
form and send check or money order for membership to:
DCFCCA
Attn: Membership
P.O. Box 22065
Eagan, MN 55122
If you have questions regarding membership you may call our voice mail at 952-985-3495.
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