Join Citizen's Oil Co-op

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First Name:		Last Name:
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City:		State:	CT RI
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Promotional Code:
Annual Membership:	Standard $25.00FREE   Application fee: $10.00   Total: $35.00$10.00	Senior (age 55+) $15.00FREE   Application fee: $10.00   Total: $25.00$10.00

The rest of this transaction will be completed on the secure PayPal site.