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1. Email Address

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2. Which social media platforms do you use?

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3. Which social media platforms do you follow us on?

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4. What type of social media content would you like to see more of?

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5. Would you be interested in receiving text messages in addition to emails from us?

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6. If you answered "Yes" to the previous question, please provide us a cell phone number.

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7. What ways do you prefer to give?

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8. How did you first hear about Alliance Medical Ministry?

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9. When is your Birthday? MM/DD

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