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Page Application

Please complete the following form to apply to be a page for Sen. Jeff King.

Prefix

Mr.
Ms.

Student's First Name ■

Student's Last Name ■

Home Address ■

City ■

County ■

Student's Grade Level ■

Student's Email Address

Student's Home Phone Number ■

Parents' First Name(s)

Parents' Last Name(s)

Parents' Home Mailing Address

City

Name of School Where You Are Enrolled ■

Special Achievements and Awards

Extracurricular, Civic, or Community Activities

Have you had previous Page experience?

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Please State Briefly Why You Want to Be a Senate Page?

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