Organization Registration

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Organization/Group Name	Centennial Rotary Pike for Vets
Primary Phone	218-256-3500
Primary Email	218-256-3500
Address	144 SE 17th Street
Address Ln 2
City	Grand Rapids
State	MN
Zip	55744

Individual Contact Information

First Name

Last Name

Cell Phone (Primary)

Phone (Alternate)

Department

Password (Minimum of 6 Characters)

Password (verify)

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