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2. 
3. Midland Youth Advisory Council
5. First Name*
6. Last Name*
7. Date*
   Date
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Telephone:*
18. E-mail Address:
20. List Clubs and Organizations in which you are currently affiliated with:
22. Briefly explain what you can contribute to the Youth Advisory Council:
24. Parent’s Name/Legal Guardian’s Name:*
25. Parent’s Name/Legal Guardian’s Signature: *
    This is a digital signature.
27. Notice:
    Please attach one letter of recommendation with this application
28. Upload Recommendation here
30. For more information please contact: Joey Jolly at 432-685-7355 or by email at jajolly@midlandtexas.gov
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

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