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Name:
Phone:
Address:
City:
Zip:
Email:
Are you a 4-H alumni?
Yes
No
Have you been a 4-H leader before?
Yes, where?
No
Topics/projects I am most interested working with:
Role I would like to have in the 4-H program (check all that apply):
Work with children grades 4-6
Work with children grades 7-9
Work with children grades 10-12
Work with children mixed grades
Community coordinator
4-H community club leader
Assistant club leader
4-H project club leader
Resource leader
Activity leader
Work with other adults
Office/clerical duties
Fundraising
Other
Comments/Suggestions:
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