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I hereby apply for membership of the Ipswich 60 and Better Program Inc. I agree to abide by the rules of the Incorporation, Code of Ethics and Procedures and the By-laws of the Association. I undertake a program’s activity at my own risk and acknowledge and voluntarily accept the level of risk relative to that activity.

I understand that information collected on this form is for the sole purpose of data collection for the Ipswich 60 and Better Program Inc. and that none of this information will be disclosed to a third party without my knowledge.