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Application for Midland Youth Advisory Council

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

    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

    For more information please contact: Joey Jolly at 432-685-7355 or by email at jajolly@midlandtexas.gov

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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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