MCA Volunteer Interest Survey

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* 1. Name:

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* 2. Email:

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* 3. I would like to participate on the following committees:

Legislative Committee

Education & Events Committee

Membership Committee

Veterans Affairs Committee

Communications Committee

Sports Council

Pediatric Council

Insurance Committee

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* 4. I am interested in serving on the Board of Directors and would like more information.

Yes

No

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* 5. Additional Comments: