Consumer Details

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* 1. First Name

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* 2. Last Name

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* 5. Email

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* 6. Are you a student?

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* 7. If yes, what school, college or university?

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* 8. As a champion for a better, more sustainable planet, please indicate which one or more of the Sustainable Development Goals you pledge to commit to within the next 12 months?

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* 9. How do you intend to support your goal or goals in the next 12 months?

10. Have you already been lending the planet a helping hand? Do you have great visions for how you can save the world? Share your accomplishments and goals for a better, brighter earth.

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* 10.a.1. I’m a volunteer

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* 10.a.2. If yes, where do you volunteer?

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* 10.a.3. Which goal or goals align with your volunteer work?

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* 10.b.1. I’m a philanthropist.

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* 10.b.2. If yes, what organizations do you contribute to?

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* 10.b.3. Which goal or goals align with your contributions?

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* 10.c.1. I’m an activist

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* 10.c.2. If yes, where are you involved?

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* 10.c.3. Which goal or goals align with your work?

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* 10.d.1. I’m a role model to family, friends and community?

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* 10.d.2. If yes, which goal or goals do you exemplify?

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* 10.d.3. What do you do as a role model?

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* 11. HealRWorld is always discovering new ways to help make the world a better place. As a champion for a better, more sustainable planet, you can receive updates, news, facts and games to support the sustainability goals.

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* 12. If yes, which goal or goals are you most interested in?

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