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Jackson County Master Recycler Program
Application - Due February 3rd, 2012
Date:
Last Name:
First Name:
Telephone Number:
Alternate Number:
Email Address:
Home address:
City:
State:		-Select text-Oregon
Zip Code:
Who is your commercial sponsor,
if any:
What is the best way/time to get in touch
with you:
What do you hope to learn in the Master Recycler Program?
-:
What experience/training/interest will you bring to the course?
-:
Why do you want to participate in the Master Recycler Program?
-:
Will you be able to volunteer the required 40 service hours?
-*:		YesNo
More than 40?*:		YesNo
Do you have any allergies or special physical needs we should be aware of? If so, please explain
-:
Any other comments or concerns?
-:
Course Requirements
-*:		Click on the "?" to read the complete course requirements.
Check if you have read and understand the Course Requirements
-*:		YesNo
Verification*:		6 add 5 =  Fill in the result