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If You Wish to Request a Waiver or Deferral of Dues, Please Form
Director will require a physician s letter indicating proof of disability each time a member requests this waiver. I authorize the release of this same attached information to the AUA Treasurer. I may revoke this authorization at any time by notifying the AUA Member Services Department in writing at the email address given on this form. I certify that the information provided in this statement is true and correct. PLEASE PRINT OR TYPE AUA Member Name Phone Fax E-mail Country The AUA requires...
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