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* 1. Please share your contact information

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* 2. Would you be able to attend the conference if childcare services were not available? 

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* 3. I need childcare services for:

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* 4. Is/are your child/ren affected? 

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* 5. Please share the age(s) of your child/ren:

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* 6. Please share any special needs your child may require:

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* 7. Is there anything else you would like us to know? 

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