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This Form, Fill it Out and Mail/Fax with Payment to: Att: Dr. Jose Acostamadiedo, Director,
Catch Cancer...Before It's Too Late!
208 Bayshore Drive, Elizabeth City NC, 27909
Fax: 252-330-4535
Tel: 252-330-4465
Product
Title
Qty
$
TOTAL
Gerard Aulong Video
NTSC Only
Blue
Marlin of Ghana
$50
Donation
International Order
$5
T
O T A L
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Address:
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ST:
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Payable To: Catch Cancer...Before It's Too Late, Inc.
Att: Dr. Jose M. Acostamadiedo
Gerard Aulong Video
