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May Grocery Distribution
1.
What is your name?
*
2.
What is a good contact number to reach you?
(Required.)
*
3.
How many people are in your family?
(Required.)
*
4.
Are you able to attend the grocery distribution on May 19th from 5:30pm to 7pm?
(Required.)
Yes
No
*
5.
Is there anything additional you need?
(Required.)