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Item	Complete Entries In This Column
Executive Director's Name Association's Complete Name	. .
Mailing Address (Complete Address Please)	.
Telephone Number (xxx) xxx-xxxx	.
Fax Number (xxx) xxx-xxxx	.
E-Mail Address	.
Website Address	.
Year 2003 NOSAC ANNUAL DUES--$250)
Payment Enclosed__ or will be mailed__	Make Check Payable To:
Date:	Jenny Crichton 309 N. Washington Square, Suite 011 Lansing, MI 48933