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County Name: <br /> <br />I~signaled Delagate: Name <br /> <br />Alternate(s) by Name and Till¢: <br /> <br />CREDENTIALS IDENTIFICATION FORM <br /> <br />Stat~: <br /> <br />Title <br /> <br />We do not want the State Association Representative to pick up our Credentials Material. (check box) ~-~ <br />Signed Title <br /> <br />Date <br /> <br /> <br />