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Bi Definition
c/o The Milwaukee LGBT Community Center
Suite 101, 315 W. Court St., Milwaukee, WI 53212

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Name  ___________________________________       Phone  (      )  ________________________

Address  ________________________________________________________________________

City  _______________________________     State  __________     ZIP  _____________________

_______        Individual  ( $15 / year)
_______        Low Income ( $7.50 / year)
_______        Enclosed an extra donation of $_______ .

Total Enclosed  $ ___________    Thank you