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2. Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Alternate Number
14. If under 18: Enter Parent or Guardian Name and Email
16. Gender
18. Education: Did you graduate from high school?

    1. Yes
    2. No
20. If no:

    What high school are you currently attending?

22. Why are you interested in being a part of the Lake County Sheriff's Department Explorer's Program?
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field