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REGISTRATION FORM
(print in landscape)
NAME ____________________________________________
ADDRESS ________________________________________
_________________________________________________
TELEPHONE ______________________________________
EMAIL ___________________________________________
AGE __________
CYCLING JERSEY (circle) S M L XL XXL
TEAM _________________________________________
___ No I cannot ride, but I would like to donate to the
Dick Melloni Youth Foundation.
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MAIL TO:
Dick Melloni Youth Foundation, c/o Richard Melloni Jr.,
7 Peter Cooper Drive, Wareham, MA 02571
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