Organization Registration

Please fill out form with necessary information and click the submit button below.

Organization/Group Name	Maplewood
Primary Phone	507-235-6606 ext 289
Primary Email	annmariefiala@lakeviewmethodist.com
Address	610 summit drive
Address Ln 2
City	Fairmont
State	mn
Zip	56031

Individual Contact Information

First Name

Last Name

Cell Phone (Primary)

Phone (Alternate)

Department

Password (Minimum of 6 Characters)

Password (verify)

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