Registration Form

Please fill out this form to register for the focus group.

Upon completion of the focus group, participants will receive a gas card and RUL program merchandise.

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1. Name: (Required.)

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2. Age (Required.)

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3. Phone number (Required.)

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4. Email (Required.)

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5. Community (County/Town) (Required.)

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6. Ethnicity or Tribal affiliation: (Required.)

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7. I agree to complete up to 2 hours of group discussion and active participation in the focus group. (Required.)

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