Love Medicine Master Mind: Stress Mastery Program Pre-Screen

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* 1. What is your preferred name?

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* 2. At what email address would you like to be contacted with your decision?

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* 3. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* 4. Do you have prior experience being a part of a supportive community?

Yes

No

Other (please specify)