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* 1. What is your gender?

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* 2. How old are you?

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* 3. What is your full name?

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* 4. Which City are you currently living in?

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* 5. Which action step are you interested in?

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* 6. Do you have a vehicle to help with action steps?

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* 7. Do you have leadership skills and/or training?

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* 8. If interested in a team leader please list your reason(s) why. 

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* 9. Please provide your email

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* 10. Please provide links to your social media

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