If you spend part of the year living at a college campus, please indicate the college you attend and local address where you reside.
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Birthdate *
MM
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DD
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YYYY
Any social media handles (Instagram, Twitter, Snapchat, Facebook, TikTok) you are willing to share so we may connect with you:
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Which high school did you attend? Which year did you graduate? *
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Where do you attend school/university and what is your area of study? And/or what is your profession/career/job and the responsibilities of that role? *
Your answer
Where do you live full-time (Town, State)? *
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If you're a current member of a Rotary/Rotaract/Interact Club, which one and where is it located?