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Text Box: KINETIC ENERGY												Page 7
Text Box: Work Assessment Validation Form
___________________________
(Member Number)    	

Member		_______________________________________________________________
						(Signature)

Member Address	_______________________________________________________________

Project		_______________________________________________________________

Project Coordinator	____________________________________________________/___________
					(Signature)					(Date)

	After a project is completed, fill in this form, sign it and have the coordinator validate with his/her signature and date.  Return before October 1 for proper current year Work Assessment credit.  Bring to a monthly meeting and place in the box provided, near the membership table, or mail to the Club’s P.O. Box.  If this form is not retuned on time, credit will not be included in membership dues renewal calculations.
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