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*Extensions apply only to medicals that have recently expired or will expire before a scheduled doctor's appointment.

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Special Olympics North Dakota Interest Form

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Name

First Name *

Last Name *

Role

I am interested in becoming a/an...

1. Athlete
2. Unified Partner
3. Coach
4. Unified Champion School
5. Other

Indicate the Area Program you are located in.

1. Area 1- Williston
2. Area 2- Minot
3. Area 3- Devils Lake
4. Area 5- Grand Forks
5. Area 6- Fargo
6. Area 7- Wahpeton
7. Area 8- Valley City
8. Area 9- Jamestown
9. Area 10- Bismarck
10. Area 11- Mandan
11. Area 12- DIckinson

Phone

Email

Preferred Method of Communication

1. Phone
2. Email