Batik Club AWS

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Batik Club Membership Registration Name: Street Address: City, State Zip: Phone #: Email Address:

 6-month membership $120  12-month membership $240 $230

Start Month: ____________________

Date Paid: ______________ Amount Paid: ________________ _____________________________________________________ Voucher Month 1 2 3 4 5 6

7 8 9 10 11 12

Date Used

Employee Initials