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Rumpke Fan Club Registration Form
*
1.
Member Name
(Required.)
2.
Name of Parent or Guardian (if applicable)
*
3.
Mailing Address
(Required.)
Street Address
City
State
Zip Code
*
4.
Email Address
(Required.)
*
5.
Phone Number
(Required.)
*
6.
Member Age
(Required.)
*
7.
Birthday Month
(Required.)
January
February
March
April
May
June
July
August
September
October
November
December
*
8.
Child Shirt Size
(Required.)
Youth XS
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
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