UDC Cooperative Extension Service 4-H Registration Form
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Participant Information
Today's Date
MM
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DD
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Name: *
Address: *
Ward: *
Telephone Number: *
Cell Phone Number:
Email Address: *
Gender: *
Race: *
Check all that apply
Required
Date of Birth *
MM
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DD
/
YYYY
Is the participant 18 years of age or older? *
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