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2. 2019 History Connector Intent Form
   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.
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