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* 1. Name

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* 2. Email address

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* 3. Name of your school

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* 4. Phone number

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* 5. Are you planning on attending a University or Technical Training?

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* 6. What is your long-term career goal?

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* 7. The object of the Rotary is to encourage and foster the idea of service as the basis of worthy enterprise.  Please list the service activities you have participated in and include the approximate total hours involved.
For example: Assisted with Cub Scouts (50 hours)

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