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* 1. Your name

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* 2. Your email

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* 3. Your campus

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* 4. Your organization/group (if applicable)

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* 5. Would you like this workshop to be open or closed?

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* 6. How many participants do you have for this workshop? (Workshops are capped at 12 participants - if your group is larger than that, you may need to split into multiple groups.)

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* 7. Do you have a location in mind for this workshop?

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* 8. Please provide three possible dates/times that would work for your group.
(Keep in mind, the Body Project consists of two two-hour workshops held a week apart, and that these dates need to be at least two weeks out from the day that you fill out this survey).

Date
Time
Date
Time
Date
Time

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* 9. Is there anything else you'd like us to know?

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* 10. What is fifteen divided by 5? (So we know you're not a robot)

T