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Retun to: Membership Information Name _____________________________________________________ Address ________________________________________________________ Telephones and Email _____________________________________________________ A Personal Vision (For Membership Directory) ________________________________________________________ PAYMENT OPTIONS Annual Membership Fee: $15 Low Income Option (specify amount) Donation to HLQ Fund: For Information All payments are tax deductible according to 501(c)3 regulations. Send to: HLQ Holistic PO Box 86054 Pittsburgh, PA 15221 |