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For consideration for 2018-2019 membership, please complete an application by June 19, 2018.  An application can be submitted below or mailed in using a paper copy.  For questions, please contact Jessie Rayment at (712)256-9920 or

Application for Membership

Please verify you meet the following critera:

Please answer the following questions honestly.

Contact Information
If accepted in to the program, do you wish to participate in once a month text message reminders?

Personal References

Signed Name