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International Fortean Research Center                Application for Membership                            Date received:_____________
P.O. Box 411                                                                                                                           Approved:_______________
Griffin, GA 30224-0411

Please print out the application, fill it with your information and mail (with payment) to the society. However, if you have opted to pay online - please check the appropriate box and fill in your transaction number.

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Name (last, first, middle):____________________________________________________________________________

Address:_________________________________________________________________________________________

City:_________________________________ State:______________________ Zip Code:________________________

Country:___________________________________ Province:______________________________________________

Date of Birth:_______________________________ Occupation:_____________________________________________