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JOHNSON COUNTY 4-H &
AGRICULTURAL FAIR ASSOCIATION, INC.


NAMES ______________________________________________________________

_____________________________________________________________________


TOWNSHIP ___________________________________________________________

TELEPHONE __________________________________________________________

ADDRESS ____________________________________________________________

CITY ZIP _____________________________________________________________


Family members over 18 years of age ___________

TOTAL AMOUNT ENCLOSED $12.00 per family _______________

DATE PAID_____________________


Mail this membership form with check to:

Teresa Wuensch, Secretary
7210 South 500 West
Trafalgar, IN 46181