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* 1. Please provide the following information:

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* 2. Do you have any dietary restrictions?

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* 3. Please identify your dietary restrictions below.

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* 4. Please identify your organization. This is not an exhaustive list, so if needed, write in your information in other.

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* 5. If you have questions you would like answered during the conference, please feel free to add them here. If not, feel free to do so the day of the event.

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* 6. How did you hear about this event? (check all that apply)

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* 7. At this time, we are prepared for participants who need interpretation (Spanish). Will you need this service?

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* 8. Does your organization have a health ministry/committee

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* 9. If your organization has a health ministry or desires to create one, the Durham County Health Ministry Network is a wonderful resource to start and sustain your efforts.  Are you interested in joining or learning more?

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* 10. Great! We love that you are interested in the Durham County Health Ministry! Please answer the questions below and we will follow up.

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