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* 1. Name

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* 2. Organization

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* 3. Email Address

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* 4. Phone

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* 5. Which designation applies to your organization?

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* 6. Which days work best for you to have a monthly 1:1?

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* 7. Which timeframes work best for you to have a monthly 1:1?

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* 8. Would you like to be notified of fellowship or training opportunities?

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* 9. Have you been awarded a BVM grant this year?

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* 10. If so, prepare a document that include details about the event or campaign that was sponsored, and be sure to include metrics and photos before your next 1:1.

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