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Value Card Membership Application Form

Value Card Application Form
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Personal Information
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  5. Gender
Work/School Information
Family Information
Spouse Name( If Married)
  1. By sending this form, I indicate my agreement to the Terms and Conditions of the Gaisano Capital Value Card Loyalty Program. I understand that should my application be denied, Gaisano Capital has no responsibility on its part to provide the reason for such rejection.
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