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* 1. What is your name?

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* 2. Please share your email address or phone number so that we can communicate additional town hall meeting details with you.

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* 3. Which Town Hall do you plan to attend?

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* 4. Including yourself, how many people are you registering to attend?

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* 5. Will you need childcare?

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* 6. If you need childcare, for how many children?

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