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* 1. First name

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* 2. Last name

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* 3. Phone number

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* 4. Email

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* 5. Are you a serving member?

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* 6. How did you find out about RSL DefenceCare?

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* 7. What service/s did you access from RSL DefenceCare?

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* 8. Did RSL DefenceCare meet your needs?

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* 9. Are you satisfied with our customer service?

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* 10. RSL DefenceCare sometimes shares stories about our clients with our donors and supporters. It is a way for us to show them how their support has allowed us to help individuals like yourself. This could take the form of your story (names and personal details withheld) posted on our website, social media sites, on a poster or brochure etc.

Do you consent to RSL DefenceCare sharing your story online/and or in publications (names and personal details withheld)?

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* 11. Can we contact you to discuss other ways of sharing your story with our supporters?

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* 12. Would you like to volunteer for RSL DefenceCare? For example, RSL DefenceCare holds fundraising and community activities and sometimes requires the help volunteers. If you would like to volunteer, enter your address below so we can make you aware of upcoming opportunities around your area. Thank you.

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* 13. Other comments and suggestions

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