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* 1. Name:

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* 2. Phone number:

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* 3. Email:

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* 4. I would like some more information

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* 5. I would like to be part of the 72 hour emergency response planning group

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* 6. I am attending the community input drop in day on November 22, 1pm - 7pm

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* 7. I would like to be updated on the progress of the plan

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* 8. Any questions or comments?

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