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* 1. What Group are you interested in?

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* 2. First name

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* 3. Surname

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* 4. Date of birth

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* 5. Phone number

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* 6. Email address

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* 7. Gender

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* 8. Ethnicity

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* 9. sexuality

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* 10. Religious beliefs

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* 11. Address

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* 12. School/College/Work details:

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* 13. GP Practice Name

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* 14. In your own words why do you wish to come to Youth Talk?

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* 15. Have you been to Youth Talk before?

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* 16. When is the best time and method to contact you?

Thank you for registering your interest. Someone will contact you soon - if you wish to contact us you can do this by phone 01727 868684 or email info@youthtalk.org.uk

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