1 Mile for Public Health Parade and Community Day 

What is your full name?

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* 1. What is your full name?

Contact number and email address

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* 2. Contact number and email address

What is your age?

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* 3. What is your age?

What is your gender?

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* 4. What is your gender?

Emergency Contact

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* 5. Emergency Contact

What is your desired level of participation?

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* 6. What is your desired level of participation?

What is your affiliation?

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* 7. What is your affiliation?

Medical accommodations

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* 8. Medical accommodations

Your feedback matters, will you be interested in taking a brief survey following this event?

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* 9. Your feedback matters, will you be interested in taking a brief survey following this event?

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