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Name

Sue Kukanza
Mobile Phone
Home Phone
Work Phone
Address 123 Any Street
City city name
Zip Code 12345
Personal Information
Sex Male
Birthday Month Day, Year (year optional, just put 0000 for year)
Soccer Credentials
USSF Grade none
NISOA Certified none
SAY Certification none
OHSAA State ID 180007
OHSAA Class none
MWSOA Member Since 2016
Certified Instructor
Certified Assessor