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            USSF ID Number 
   State Transferring From 

      Enter South Carolina Information Below     

                First Name 
               Middle Name 
                 Last Name 
           Street Address1 
           Street Address2 
                      City 
                     State 
           Zip/Postal Code  - 
           Gender (M or F) 
 Date of Birth (mm/dd/yyyy)
          Country of Birth 
    Country of Citizenship 
                Work Phone 
                Home Phone 
            E-mail Address 

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