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Member Application Form
Years in Operation
Business Owner Name:
Business Owner Email:
Email (We Will Reply to This Email):
Phone Number (Numbers Only):
Alternate's Full Name:
Alternate's Phone Number (Numbers Only):
70% of my business activities are:
30% of my business activities are:
As a new member of the Breakfast Club of Regina, we will follow the constitution of the Breakfast Club of Regina Inc. and maintain a 67% attendance record per year.
We will pay the first six (6) months of fees upon approval of our membership.
Member Sponsor Information
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