Contestant Name

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* 2. Contestant Name

Address, City, City, State, Zip

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* 3. Address, City, City, State, Zip

Primary Telephone Number / Cell Phone Number

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* 4. Primary Telephone Number / Cell Phone Number

How man CMNH Hours have your worked/CMNH Donations Monies Raised  (Ex. Children Miracle Network Dairy Queen, CMNH Hospital visitation, Promoting CMNH in anyway) 

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* 5. How man CMNH Hours have your worked/CMNH Donations Monies Raised  (Ex. Children Miracle Network Dairy Queen, CMNH Hospital visitation, Promoting CMNH in anyway) 

Community Service Project Name (Name of Your Platform)

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* 6. Community Service Project Name (Name of Your Platform)

Your Community Service Project (Platform) Hours

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* 7. Your Community Service Project (Platform) Hours

Community Service Amount Raised  (Total Amount of money you have raised in the past year with your platform)

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* 8. Community Service Amount Raised  (Total Amount of money you have raised in the past year with your platform)

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