October 24th, 2026
1:00pm-2:00pm ET

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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Phone Number

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* 5. Age

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* 6. Gender

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* 7. Race/Ethnicity (please check all that apply)

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* 8. City and State of Residence

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* 9. On a scale from 1 to 7, how knowledgeable are you about environmental health?

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* 10. On a scale from 1 to 7, how knowledgeable are you about community engagement & empowerment?

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* 11. Are you interested in participating in this month's healthy challenge?

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* 12. If you would like to receive a wellness give-away, please provide an address where you would like us to send your items.

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