Wissinoming Boys Club
4133 Van Kirk St, Philadelphia, PA 19135 l 215-535-9199 l info@wissbc.com
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Wissinoming Boys Club Registration 2008
Please enter child's information below:
Name: Date of Birth: (mm/dd/yyyy)
Address:
City: State: Zip:
Phone Number: (xxx-xxx-xxxx)
Gender: Male Female
Email Address:
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Basketball
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Last Updated 7/13/08