To find out if your town is available, & receive more information please fill out the following:

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* 1. To find out if your town is available, & receive more information please fill out the following:

Why do you feel you are a good candidate to lead your town in Kids Day America/International?

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* 2. Why do you feel you are a good candidate to lead your town in Kids Day America/International?

What Chiropractic College did you graduate from?

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* 3. What Chiropractic College did you graduate from?

What year did you graduate from Chiropractic College?

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* 4. What year did you graduate from Chiropractic College?

Enter the best day & time during the next week for you to receive a call (two options please). All calls based on Eastern Standard Time (NYC)

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* 5. Enter the best day & time during the next week for you to receive a call (two options please). All calls based on Eastern Standard Time (NYC)

Date / Time
Date / Time

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