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* 1. First and Last Name/ Age group (Child, Youth, IHOPE, Middle Aged, Senior Saints)

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* 2. Address

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* 3. City/State/Zip Code

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* 4. Phone

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* 5. Male or Female 

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* 6. Email

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* 7. Alternate Phone Number 

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* 8. Order your preferred Areas of Interests (Mentoring Program, Financial Freedom, Self Care, Education, Culinary Cuisine)

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* 9. Order your preferred Generation of Interests that you would like to work with (Children, Youth, Young Adult, Senior Saints, or other- If other please explain)

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* 10. Do you have any additional questions about Building the Vision to Bridge the Gap?

0 of 10 answered
 

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