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___________________________________________________________________

MEMBERSHIP APPLICATION

FOR

UNION CAMPGROUND

CEMETERY ASSOCIATION, INC.

Name ___________________________________________

Address _________________________________________

              __________________________________________

Phone number(s) ___________________________________

Email Address _____________________________________

Individual ($15) membership ___    Family ($25) membership ____

Do you have any family members buried at the cemetery (and who)?

________________________________________________________

________________________________________________________

How did you hear about our organization? _____________________

________________________________________________________

Please copy this form and mail it and your check to:

Doug Rayl, Treasurer
Union Campground Cemetery Association
252 Hightower St.
Nixa, MO  65714


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