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* 1. Full Name and Enrollment Number (must be an enrolled Washoe Tribal member living off-reservation; each household is eligible to receive one (1) care package)

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* 2. Physical Address (include City, State, and Zip)

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* 3. Mailing Address (if same as physical address, write "SAME")

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* 4. Phone Number

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* 5. Email

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* 6. Household Size (also include number of children, if applicable, in case child-size masks are needed)

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* 7. Are you in need of reusable/washable cloth masks for your household?

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* 8. Are you in need of a care package containing canned food and general household supplies?

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* 9. Would you prefer a gift card instead of a care package, if it is an option?

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* 10. Please select the methods that you are able to access and/or receive a care package (select all that apply):

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