NORTH CAROLINA PUMPER GROUP

Application for Membership (printable version)

Firm/Organization/Individual: ________________________________________

Contact person: __________________________________________________

Address: _______________________________________________________
                  (Street)                   (City)                                     (State)    (Zip code)     

Telephone: ______________________________________________________
                        (Work)                         (Home)                      (Fax)

What goals do you wish to see accomplished? ____________________________

_______________________________________________________________

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Return to:
North Carolina Pumper Group
Post Office Box 430
Oriental, North Carolina 28571
office (252) 249-1097
fax (252) 249-3275