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AMUSEMENT & MUSIC
OPERATORS OF TEXAS ----------Please print this out and mail to the address above.---------- Bar Location Membership Application Name________________________________________________________________________ Business Name________________________________________________________________ Business Address______________________________________________________________ City_______________________State___________Zip_______________County____________ Phone________________________Fax_____________________Email___________________ Location Member dues $100.00
Dues are payable January 1st and Expire December 31st each year.
Signature_________________________________________Date___________________________ Please charge the following credit card: Name on card:__________________________________________________________ Card No:______________________________________Exp. Date:________________ Type of Card: ___________________________________
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