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Organizational Membership Application Citygate Network Form
After the 25th of the month for the following month. By virtue of Regulations and Policies. I we hereby authorize and direct Chan Soon-Shiong Medical Center at Windber s Portage HealthStyles to initiate debit entries to my our Checking/Savings account indicated above and the bank named to debit the same to such account for prepayment of monthly dues or other unpaid charges. The programs may involve walking jogging swimming or cycling participation in exercise fitness rhythmic aerobic exercises...
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