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South Dakota Jaycees Speak Up Program

Registration Form

Name: ____________________________________________________________________

Address: __________________________________________________________________

__________________________________________________________________________

Telephone:
Home:
_____________________
Work:
_____________________

E-Mail Address: ___________________________________________

Chapter: _________________________________________________

Estimated time of arrival at State Convention Headquarters: _________________

Please feel free to contact Dawn Connor with any questions.

Dawn Connor
752 Lion Dr.
Rapid City, SD 57701
(605) 388-0384 home
(605) 719-0144 work
funkhole@aol.com

 

 

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