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IGD Application Form
Date:(ex. 00/00/0000)
Gender:
Name: (First, Last)
Age:
D.O.B
Phone:
Best Time to Call
Medical Conditions and Medications we hould know about.
Felony Convictions in the past 2 years. This does not necessarily exclude you from joining. If yes explain.
YES
NO
Why do you, your organization or group wish to join IGD?
What can IGD do for you?
Do you give IGD permission to use your photo or pictures of you or that you have taken, on our website?
YES
NO
By entering your intials below you acknowledge that you are making a lawful digital signature upon this application.
Address:
E-mail Address:
Emergency Contact Name:
Emergency Contact Number:
Are you 18 or over?
Yes
No