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* 1. Full Name:

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* 2. Email Address:

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* 3. What club do you play for?

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* 4. What is your hometown?

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* 5. What is your offseason home (if different than the above 2)?

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* 6. I’d be willing to travel to another state for an appearance:

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* 7. I’m interested in (check all that apply):

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* 8. Is there anything else you would hope to gain through a connection to the various USYS state associations?

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