Name of Federation: __________________________________________________________
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Address: ___________________________________________________________________
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City: ________________________ State/Province: __________________ Postal Code________
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Telephone (Day): _____________________________ Fax:__________________________
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E-Mail: _______________________________________________________________
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Federation President: ________________________________________________________
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Federation Secretary: _______________________________________________________
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Official Submitting Form: ____________________________________Title: _______________
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Telephone: _________________________________ Fax: ____________________________
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E-Mail: __________________________________________________________
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Required - Tournament Federation Code: ___________
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