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History Connector Intent Form

2. 2019 History Connector Intent Form
   Please submit by December 14, 2018

   Please submit by December 14, 2018

4. Name*

6. Street Address*

8. City, State*

10. Zip Code*

12. Primary Telephone Number*

14. Email *

16. If you are 18 or under, please provide the following information.

    If you are 18 or under, please provide the following information.

18. Date of Birth

20. School Name

22. Year of Graduation

24. Intent*

    Yes I will be returning as a History Connector for the 2019 season.

    1. April - October commitment - two 3.5 hour shifts per month
    2. June, July, August - four 3.5 hour shifts per month
    3. No I am no longer available to take part in the History Connector program
26. Comments

28. Thank you for your service! We look forward to working with you in 2019.

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field