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Be an Achieve  Sponsor

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Payment options appear after this form.   Unfortunately, golf is not available. 

Please press the "Submit" button on the form above before making payment.  

Mail check and copy of this form to:

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Charlene Mixa

5048 Pinnacle Drive

Oldsmar, FL  34677

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For additional information, call:

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727.753.3111

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Submit the form above and pay by credit card:

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OR

Thank you
for your registration.  We will confirm by email.

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