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Member r
Non-Member r
Parent/Guardian 2____________________________________________
Work Phone ______________________ Cell______________________
Email _____________________________________________________
Work Phone ______________________ Cell______________________
Email ____________________________________________________
Date____________________________________________________
Date___________________________________________________
Weinstein JCC • 5403 Monument Avenue • Richmond, VA • 23226 • Fax (804) 285-3139
Mail your Registration Forms to the address below or drop off at Weinstein JCC Central Services/Con