Please fill out the information below to register for the Lunch & Learn Event. All information will be kept confidential with Agape House.

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* 1. What date are you attending the Lunch & Learn?

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* 2. Name (Only first name is required):

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* 4. Phone (optional):

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* 5. What town/region are you coming from?

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* 6. Have you heard about Agape House before?

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* 7. How familiar are you with sexual violence?

Not Familiar I know a little bit Very Familiar
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* 8. Lunch, soft drinks, and water will be provided. Do you have any dietary restrictions we should know about (ex. lactose or gluten-free)? This information will be needed by March 18th to make appropriate arrangements.

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