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The rebate is paid to the Tufts Health Plan subscriber after fitness center fees are paid* 1. Member s Name Please print in capitals ________________________________________________________________________ Last First MI 2. Member s Tufts Health Plan ID 3. Proof of payment through one of the following Please indicate which one of the following forms of proof of payment you are including with this form q n itemized receipt from the fitness club showing the dates of membership and A ...

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