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P.O. Box 192 • 101 E. Winslow Street, Middlebury, IN 46540
Phone: 574-825-5601 • Fax: 574-825-5150

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Teen Advisory Board Registration

*Required fields

*Name

*Phone number

Grade

E-mail address

Preferred day to meet (Mon, Tues, Wed or Fri)

Preferred time to meet

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