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1. Name (Required.)

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2. How many participants (including you) will be attending? (Required.)

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3. Would you like to give a personal testimony at this event? (Required.)

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4. For remembrance would you like your child's name read aloud during the reading of names ceremony? If so please type out your child’s name and pronunciation below. (Optional)

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5. If you’d like extra support or resources please contact the Family Advocacy Program at (208) 828-7520.

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