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* 1. Are you interested in any of the following positions (check all that apply):

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* 2. What type of activities would you like to see the Parents Club do more of (check all that apply):

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* 3. What location would you prefer events to take place?

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* 4. How far are you willing to travel (in miles) to participate in Parents Club events?

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* 5. Comments

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* 6. Parents Club Name

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* 7. Your Full Name

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* 8. Your Email Address

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* 9. Your Zip Code

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