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2. Last Name*
3. First Name*
5. Phone Number*
7. Street Name*
9. Street Number*
11. Unit (If Applicable)
13. Email Address*
15. Authorization

    I give authorization to the Town Clerk to include my name and address on the Town of Bellingham's DO NOT SOLICIT Registry.

16. Authorization*

    1. Yes
    2. No
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

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