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Morton WyldLife Club Card
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First Name
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Last Name
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Address
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City
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State
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Zip Code
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Your Email
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Your Cell #
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Birthdate
MM
/
DD
/
YYYY
Current Grade
7
8
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Male or Female
Male
Female
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School
Bethel Lutheran
Homeschooled
Morton Junior High
Other
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Parent / Guardian Last Name (who you live with)
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Parent / Guardian First Name
List both Dad and Mom if applicable
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Parent Cell Phone
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Parent Email
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