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Get Washington State Grange Youth Form

Previous last name (married or birth name). ADDRESS: CITY: STATE: DATE OF BIRTH: ZIP: SEX: SOCIAL SECURITY # (optional): DRIVER S LICENSE #: JUNIOR LEADER: YES NO CAMP WORKER: YES NO CAMP(S) I plan to work at: By signing this form you fully understand the Washington State Grange will run a background check on you with the Washington State Patrol. (Anyone under the age of 18, must have a parent signature prior to returning this form.) Signature Date: Parent s Signature (Required f.

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