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* 1. Parents Club Name

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* 2. Your Name

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* 3. Email Address

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* 4. Phone Number

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* 5. Activities I am most interested in are (check all that apply):

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* 6. I would most like to hear about events through (choose one):

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* 7. I prefer events that occur:

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* 8. I would like to see events include (check all that apply):

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