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Maci Wainwright Fan Club Membership Application PO Box 950 Bethany, OK 73008 Name:_______________________________ Address:_____________________________ City:___________ State:____ Zip Code:_____ Phone____________ Phone #2___________ Email________________________________ Birthday:_________ Anniversary:__________ Mail Preference ___Email ___ US Post office ________________________________ For Official Use Only Membership Date:_____ Member # _______ Membership Type:_______ Full ________Student
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