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The Love Detroit Prevention Coalition Committee Sign-Up Form
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1.
First Name
(Required.)
*
2.
Last Name
(Required.)
3.
Email Address
*
4.
Phone Number
(Required.)
*
5.
Your signing up for our LDPC Committee as a:
(Required.)
Youth
Parent
6.
If signing up as a youth, what is your age?
7.
If signing up as a youth, what school do you attend?
