My name and email address are:

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* 1. My name and email address are:

I currently hold:

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* 2. I currently hold:

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

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

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

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

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

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

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

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

I have an updated rule book:

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* 7. I have an updated rule book:

I have volunteered in the following areas:

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* 8. I have volunteered in the following areas:

I would like to shadow in the following areas:

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

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

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

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