* 1. My name and email address are:

* 2. I currently hold:

* 3. I have attended a Stroke & Turn Clinic in the past:

* 4. I plan to attend a Stroke & Turn Clinic this year:

* 5. I have attended a Starter/Referee Clinic in the past:

* 6. I would be interested in attending a Starter/Referee Clinic this year:

* 7. I have an updated rule book:

* 8. I have volunteered in the following areas:

* 9. I would like to shadow in the following areas:

* 10. I would be happy to have someone shadow me in the following areas:

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