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Are you available for evening meetings? <br />References: <br />Name: Phone: <br />Relationship to you: <br />Name: Phone: <br />Relationship to you: <br />Applicant Signature: <br />Parent /Guardian Signature: <br />Please return this application in person or via mail to: <br />Heather Jones <br />Cabarrus County 4 -H <br />715 Cabarrus Ave. West <br />Concord, NC 28027 <br />(704)920 -3310 — fax <br />hrjones @cabarruscounty.us <br />Date: <br />Ad& <br />smote tMiversih <br />A87 State Univeis,ry <br />COOPERATIVE <br />AIMMEMIN EXTENSION <br />•.. -, - fmtauc�vng PaoWe • HoKdirg SW�fions <br />11/2010 <br />Attachment number 6 <br />1 -1 Page 273 <br />