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* 1. What is the name of the person served? 

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* 2. What is their phone number?

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* 3. Please select the most appropriate result(s) from the choices below:

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* 4. What is the their gender?

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* 5. Please define the their physical maturity level?

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* 6. How did you come into contact with them?

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* 7. Your Name (OCBF Member)

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* 8. As an OCBF Member, what ministry area you under?

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