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* 1. Full Name

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* 2. Email Address

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* 3. Phone Number  (###-###-####)

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* 4. Which location(s) would you be interested in volunteering?

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* 5. Address

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* 6. Emergency Contact Info (required If you are under age)

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* 7. Why do you want to be a Freedom Defender? Why is it important to walk together as a movement?

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* 8. Nominate a friend to be a "Freedom Walker" or "Freedom Defender"

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* 9. How did you find out about the Freedom Walks?

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* 10. Do you have any questions or would you like to give any additional feedback?

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