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Organization Registration
Please fill out form with necessary information and click the submit button below.
Organization/Group Name
MCNB Retirees Group
Primary Phone
5072361458
Primary Email
carolyn56@frontiernet.net
Address
218 w 10th st
Address Ln 2
City
Fairmont
State
Mn
Zip
56031
Individual Contact Information
First Name
Last Name
Cell Phone
(Primary)
Phone
(Alternate)
Department
Email
Password
(Minimum of 6 Characters)
Password
(verify)
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