Name

Name on name tag

FFYR Position/Title

Address

City/State

Zip

Phone

E-mail

Local Club

Your position in club

Today's date

(e.g., Bob instead of Robert)

(If none put "member")

Note:

Terms of Agreement

(If none put "none" in box)

(If none put "none" in box)

* tax not included

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This signature must be that of the individual "signing" this registration electronically or be made with the full knowledge and permission of the individual, otherwise it constitutes forgery under s.831.06, Florida Statutes.  By electronically signing this registration you enter into an agrement with the FFYR and agree with the Terms of Agreement.

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