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* 1. What is your age group?

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* 2. What is your gender?

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* 3. Please fill in your preferred method of communication.

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* 4. How often should we send you information?

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* 5. Would you like to receive any of the following?

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* 6. How did you hear about us initially?

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* 7. Have you ever volunteered with Heart House Hospice?:

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* 8. Would you like to learn about volunteer opportunities?

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* 9. Have you attended any of our events?

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* 10. Would you like to attend our events?

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* 11. Are you a monthly donor?

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* 12. Would you consider putting Heart House Hospice in your will?

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* 13. Please feel free to add any comments and suggestions below.

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