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Name___________________________________
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Address_________________________________
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City____________________________________
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State___________________________________
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Zip_____________________________________
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Phone Number____________________________
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E-mail__________________________________
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Check items of interest below:
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Wherever needed_________________________
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Greeter__________________________________
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Walk about______________________________
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Sell items at Fundraiser_____________________
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Raffle Tickets_____________________________
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Other___________________________________
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How did you hear about us?
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