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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Age

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* 5. Gender

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* 6. Do you currently have school-age children residing with you?

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* 7. Community Space
Please select the way you would like to see community space available to the public.

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* 8. Physical Fitness
Please select the type of classes you are interested in.

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* 9. Arts & Entertainment
Please select the types of classes you are interested in.

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* 10. Theater & Movie
Please select the type of classes you are interested in.

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* 11. Recreation
Please select the type of classes you are interested in.

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* 12. Education
Please select the type of classes you are interested in.

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* 13. Notes or Comments
Please provide any notes or comments relative to your survey responses. Please include any additional experiences you think should be considered.

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* 14. Survey Results
PLEASE NOTE that survey results will be available on the QoL Dept Facebook page once the results are compiled but please let us know if you want to receive a link to them by email.

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* 15. Future Notifications
Let us know if you want to be contacted about future classes, programs & events provided by the City of Panama City Quality of Life Department.

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