AMERICAN IMPRESSIONIST SOCIETY
856 5th Place
Vero Beach FL 32962
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MEMBERSHIP APPLICATION

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Name
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Street
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City	State	Zip
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Telephone	Fax	E-Mail
Summer Address (if applicable)
From: ________________ To:__________________
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Street
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City	State	Zip
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Telephone	Fax	E-Mail
Include check for $50.00; payable to American Impressionist Society, Inc., and mail to: T.R. Dickinson, Treasurer, 856 5th Place, Vero Beach FL 32962