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Demand the Change for Children List
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1.
First Name
(Required.)
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2.
Last Name:
(Required.)
3.
Mailing Address:
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4.
City
(Required.)
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5.
State:
(Required.)
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6.
Zip:
(Required.)
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7.
E-mail Address:
(Required.)
8.
Why do you care about preventing child sexual abuse? (Please check all that apply.)
I am a parent of a child(ren) under age 18.
I am a responsible adult, concerned about the safety of all children.
I have friends and/or family who were sexually abused as children.
I have friends and/or family with sexual behavior problems.
I was sexually abused in childhood.
I work with children and/or families.
I want to take action to prevent child sexual abuse.
I prefer not to answer.
Other (please specify)
9.
I permit Demand the Change for Children/Minnesota Coalition Against Sexual Assault to list me as supporting child sexual abuse prevention.
Yes
No
10.
I want to be kept informed via periodic e-mail updates about efforts to Demand the Change for Children.
Yes
No
11.
I want to get involved in making my community safer for all children. Please let me know how I can help.
Yes
No