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Thank You for your interest in Rotary Youth Exchange

Please provide the following information:

First Name
Last Name
Sex	Male Female
Date of Birth
School Name
I am interested in: (check either or both)	Summer Exchange Academic Year Exchange
Your Street Address
City
State
Zip Code
Phone
E-mail
I am interested in the following three countries	You must select 3 different countries! Unlisted Country: Unlisted Country: Unlisted Country:
Any comments for us that you would like to send along?