Roberti, Barbara
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New York State Department of State '
January ;wo;r ;;20//
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(Print Name)
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TOWN CLERK
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Personal Training Record
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Title of Session
Training Provider
Location
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, a member of the Zon'~ V) ~ AdM en .
(Name the Board You Have Been Appointed To)
certify that I attended the programs descrO
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Date)
Please file this record with the Town Clerk
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