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Partnership Pledge and Enrollment Form

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* 1. Business Information

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* 2. Please indicate the number of t-shirts, by size, for your full time employees

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* 3. Please indicate below what types of supports your organization will be able to provide for the Last Chance Challenge (August 30th - September 19th): check all that apply.

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* 4. Your local health department would like to showcase your participation in the Last Chance Challenge on social, digital and/or paid media (this would include sharing photos and business name and location). Please indicate below if you agree to your business being showcased.

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