Thank you for your Interest in this Event

Event Date and Time:
September 29, 2021
1:00PM - 3:00PM

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* 1. Organization Name

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* 2. Is your organization a community-based organization with a non-profit 501(c)(3) status?

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* 3. What type of services does your agency provide to the Santa Clara county community?

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* 4. Does your organization currently have any contracts with the County of Santa Clara?

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* 5. What is your organization's Tax ID number?

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* 6. Registrant Name

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* 7. Registrant Title

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* 8. Registrant Phone 

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* 9. Registrant E-mail Address

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