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* 1. Name

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* 2. Email Address

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* 3. Phone Number (optional, only for minimal use)

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* 4. Do you have any special skills and/or interests that would be be helpful for the campaign?

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* 5. Would you be willing to host a host or apartment party (a small gathering of voters in the South End to meet Mohamed and/ or fundraise)

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* 6. What is your address? 

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