                             Registration Form
			David's Christian Wallpaper III
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Full Name _______________________		Date __________________

Address _________________________		City ___________________

State/Provence __________________		Zip ______________	

		Country____________	Telephone _______________	

		E-MAIL ____________	

Please indicate amount paid.  [ ]$10.00  ([ ]$5.00 donation)  [ ]other

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Please make check or money order out to: David Peterson

Mail Registration and payment to:

David Peterson
209 Lincoln St.
Lewiston, ME  04240


