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Umber Mailing Address - Cell/Phone (Street or PO Box) Sex - Male Female (City) (State) Date of Birth (Zip) Place of Birth Will You Be Employed Elsewhere This Summer? Yes No If Yes, Where? *Summer Conference may require long hours during both the weekdays and weekends. Preference will be given to those students who will be able to commit to these hours. * Dates of summer employment, approximately: May 12th August 12th Are you planning to attend summer school? Yes No Please.

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