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Be a Pink Power Sponsor

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Payment options appear after this form. 

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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