Please print, complete and mail this
form along with payment to: NETXCM, P O Box
994, Commerce, TX 75429 |
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One Year Family Membership:
$50 One
Year Grandparent Membership: $30
One Year Family Plus Membership: $60 |
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| Family Name |
__________________________
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| Address |
__________________________ |
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| City, State |
__________________________ |
Zip code: ___________________ |
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| Business Phone |
__________________________ |
Home Phone _______________ |
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| e-mail |
__________________________ |
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| Family memberships include all
individuals living in the same household. Grandparent memberships
include all grandchildren regardless of their address. Family Plus
memberships include one extra caregiver (grandparent, nanny, other
relative) |
| Adult 1
___________________________________ |
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| Adult 2
__________________________________ |
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| Family Plus: additional adult:
_________________________ |
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| Child 1 _________________________________
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Age _______ |
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| Child 2 _________________________________ |
Age _______ |
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| Child 3 _________________________________ |
Age _______ |
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| Child 4 _________________________________
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Age _______ |
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Child
5_________________________________
Age _______ |
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