Professional Documents
Culture Documents
Life Wave
Life Wave
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Member Signature ~
By (Member#) C; 99008
***Memberwiil be moved to the bottom oUbe sponsor's Jeg that is circled***
Print name ofSponsor )) d:1/ ,J1.,_~S~.A_A)__'('__k'_"'t'_" :¿~_Co=:""",,-,'.,-",e,-,J"-.,,/Jc-'V'W=-' '-"--_{¡!-'#CL' G9 '1 <;:, 1S) S rc:'JJo:z
Expiration Date: _
Security Code: _
Enter the address where you receive your credit card statement
Streetaddress: <:/E'I'1¡(¡'
, ~(vL¡,/{:1 of¿ 1/1(. (.4/., 8
City: CÓ,141Vc. ~~'-- _
By signing this requesr form the member agrees to a processing fee of ñfty dollars ($50.00) for rhís move. The fee
is applícable regardless of time the request was submitted.