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Membership Level* – Please Select – Gold Platinum
Doctor* Alan Pocinki - Not accepting new patients at this time
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Legal First Name* M.I. Last Name*
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I declare that I am the member's parent or legal guardian registering my ward.
Members must be at least 16 years old to enroll.
Email*
Phone Number* Mobile Home Office Best time to call... - Select - Anytime Morning Afternoon Evening
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