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I'm interested in Pleasant Acres 4-H Club

Please tell us about yourself. Our membership chair will contact you about the club. This information will only be used to contact you about Pleasant Acres 4-H Club..

Please provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
City
State
Zip Code
Home Phone
E-mail

How old are you?

What grade in school are you?

What 4-H projects are you most interested in? (It's ok to leave this empty.)


 

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Revised: September 19, 2005