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* 1. Name

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* 2. Mailing Address

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* 3. E-Mail

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* 4. Home Phone

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* 5. Cell Phone

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* 6. Name of 4-H Club(s)  & Leader(s) where you were a member:

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* 7. Please give a brief personal description of yourself. Things you might include: When you were a 4-H member; Projects; Trips; Personal benefits: Career choices; Marital status; Children; Employment; etc.

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