Membership Data

Kehewin Covid 19 Emergency Management is Seeking important data on it's membership.

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* 1. Your Full Name

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* 2. Address 

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* 3. Are you or any members in you home at risk?

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* 4. Would you like to receive information updates via

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* 5. Allergies or food requirements?

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* 6. Number of members and ages in the home

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* 7. Are you Currently in need of assistance?

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* 8. Would you like to have follow up to this survey?

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