[ Katz ] ]

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[ How would you like to be addressed as? ]

—  NAME  —

—  HE/SHE/THEY  —

[ Some basic information about you ]

—  AGE RANGE  —

| 12-14 | 15-17 | 18-20 | 21+ |

—  TIMEZONE  —

— SCREENSHOT OF ACTIVITY  —

[ Are you familiar with our [guidelines]

and are you confident to learn them by heart? ]

— YES/NO —

[ Why would you like to ? ]

—  JUST TELL US HOW YOU DISCOVERED THIS

CLUB AND WHAT CAUGHT YOUR ATTENTION TO

THE POINT IT MADE YOU WANT TO APPLY —

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