Junior Civitan Club 2020-2021
Membership Application
Email *
First Name *
Last Name *
Age *
*
Address *
phone number *
Home Room Teacher *
birthdate *
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cmcss email *
personal email
Parent's Name *
Parent's email *
Parent's phone number *
I hereby request membership in the Montgomery Central Middle School Junior Civitan Club. I agree to abide by the international, district and club constitutions, bylaws and policies and the Code of Conduct as established by Montgomery County.         Signature *
What other projects would you like to see brought to the school for the student body? (choose up to 5) *
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