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2020-2021 Membership Application
Member Information
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* Indicates required question
Email
*
Your email
Member First Name
*
Your answer
Member Middle Name
*
Your answer
Member Last Name
*
Your answer
Nickame
*
Your answer
Gender
*
Female
Male
Prefer not to say
Date of Birth
*
MM
/
DD
/
YYYY
Age
*
Your answer
Street Address
*
Your answer
City
*
Bryan
Beeville
Caldwell
College Station
Snook
Hearne
Other:
Zip Code
*
Your answer
Ethnicity
*
Hispanic or Latino
Not Hispanic or Latino
Race
*
American Indian/Alaskan Native
Black or African American
White
Native Hawaiian or Pacific Islander
Asian
Hispanic or Latino
Black/African American & White
Black/African American & Hispanic/Latino
Hispanic/Latino & White
Other:
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