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1. First Name (Required.)

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2. Last Name (Required.)

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3. Email (Required.)

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4. Phone number

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5. Will you attend the March 6, 2013 screening of Weight of the Nation (Consequences)? (Required.)

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6. Will you attend the March 13 screening of Weight of the Nation (Choices)? (Required.)

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7. Will you attend the March 20 screening of Weight of the Nation (Children in Crisis)? (Required.)

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8. Will you attend the March 27 screening of Weight of the Nation (Challenges)? (Required.)

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