7.
I declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and
correct and that I have remitted the required fee.
Signature of Organizer
Month
Day
Year
X
Name of Signer (printed or typed)
Title/Position
Phone Number
Address
City
State
Zip
Signature of Organizer
Month
Day
Year
X
Name of Signer (printed or typed)
Title/Position
Phone Number
Address
City
State
Zip
Please review to ensure completion.
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Rev. 6/20/12 nr