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Application - Renew - VE

  Call           QCWA # (if you know what it is!)
Name first   mi   nick   last   suffix
Address 1
Province or Territory   Postal Code   -
Country     E-mail  
() - Date of Birth   // mm/dd/yyyy
I wish to be affiliated with QCWA Chapter       view Active Chapters
Email ID of the person submitting the application if other than the Applicant:  
Comment or additional chapters you belong to.
Application - Renew - VE
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each 4 pay Life Membership payment.

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