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4-H/FFA Member (or Parent/Guardian) FIRST Name(s) (If more than one child in your family, enter all of their names here.)
4-H/FFA Member (or Parent/Guardian) LAST Name(s)
Premise ID Number
This institution is an equal opportunity provider. For the full non-discrimination statement or accommodation inquiries, go to
www.extension.iastate.edu/legal.
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