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* 1. First Name

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* 2. Las Name

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* 3. Email

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* 4. Phone

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* 5. Are you a current UACC congregational member?

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* 6. Which Board, Mission, or Group do you represent or participate in?   (Check all that apply)

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* 7. What activities would you like to see happen in the Avazian Fellowship Hall?   (Check all that apply)

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