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Morton Young Life 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
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DD
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YYYY
Current Grade
12
11
10
9
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Male or Female
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Female
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School
Morton High School
Other
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Parent Last Name (s) (who you live with)
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Parent First Name(s)
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Parent Phone
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Parent Email
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