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Dept. Address
City State Zip
Dept. Phone
E-mail Address
Beneficiary's Name
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Preferred Mailing Address if Different From Above:
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Address
City State Zip

U.S.D.S.A. LIFETIME
MEMBERSHIP FEE: $20

This one-time fee of $20 will apply to new members only. No fee applies to current members. Please be sure to complete payment information below.

METHOD OF PAYMENT

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Mail to:
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