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* 2. Today's Date

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* 3. Please enter your first and last name.

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* 4. Please enter your email address.

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* 5. Select the year(s) you donated to Love Bags (Select all that apply).

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* 6. How did you hear about Love Bags?

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* 8. Please select items you're donating (Select all that apply).

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* 9. Please specify the quantity for each item donated (ex: 100 count Q-tips, 25 count Tampons, 2 12-oz bottles of Body Lotion, 3 travel-sized Body Washes, 12 travel-sized Toothpastes, 10 Band-aids, etc..).

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* 10. How likely are you to donate to Love Bags again?

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