MADD Sign-Up! Survey

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1. Please enter your first and last name.

Please enter your first and last name.

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2. What is your email address?

What is your email address?

3. What is your program year?

What is your program year? Freshman

Sophomore

Junior

Senior

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4. Of the organizations listed below, please select which organization would be your first choice to volunteer at for Make A Difference Day 2012

Of the organizations listed below, please select which organization would be your first choice to volunteer at for Make A Difference Day 2012 Pipestem State Park (campsite restoration)

Concord Child Development Center (painting, cleaning, organizing)

The Wade Center (painting, cleaning, organizing)

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5. Of the organizations listed below, please select which organization would be your second choice to volunteer at for Make a Difference Day 2012

Of the organizations listed below, please select which organization would be your second choice to volunteer at for Make a Difference Day 2012 Pipestem State Park (campsite restoration)

Concord Child Development Center (painting, cleaning, organizing)

The Wade Center (painting, cleaning, organizing)

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6. What is your t-shirt size?

What is your t-shirt size? Small

Medium

Large

X-Large

XX-Large

XXX-Large

Other (please specify)