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    Camellia Society of the Potomac Valley
    Kathleen Graham
    8906 Beauchamp Dr.
    Alexandria, VA 22309

    Your name: ______________________________________________

    Address:     ______________________________________________

                      ______________________________________________

    Telephone:  ___________________________
    EMail:        ___________________________

    Amount:     $__________

    Annual dues are $10.00 for regular membership,
    $15.00 for sustaining memberships.

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