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UBC Benovelence Fund Registration Form





















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Emergency Contact:

Life Insurance Information (Optional):

Beneficiary Information:

Acknowledgement:

By signing this form, I certify that the above information is true, if found to be falsified, I am aware that I could lose my membership and all accompanying benefits. Completing and submitting this to the Upendo Administration Church’s Office, constitutes to your agreement to abide by constitution and regulations governing the Church.

Member Signature



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