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| First Name |
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| Last Name |
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| Your E-mail |
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| Address |
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| City |
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| County |
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| Zip Code |
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| Country |
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| Phone |
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| Date Of Birth |
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| Spouse Name |
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| Child-1 Name/Age |
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| Child-2 Name/Age |
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| Child-3 Name/Age |
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| Child-4 Name/Age |
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| Do you want to Join the Hui'O Hawai'i of Yuma? (Please indicate yes or no) |
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| Do you want to volunteer for a position in the |
| Hui'O Hawai'i of Yuma? |
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| Please describe experience with chosen position/s. |
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| Do you have hidden talents in these areas?: |
| Dance (Hula), Singing, Playing and Instrument, Cooking, Internet, Web Design, |
| Disc Jockey, Desktop Publishing, Computer Abilities, Legal Expertise, Eating, |
| Newsletters, Fund Raising, Charitable Organizations, Event Coordination, |
| Other applicable abilities (please explain) |
| If so tell use about you abilities: |
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| Any additional comments, recommendations, |
| questions or areas of concern? Please use this space. |
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Security Code*
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