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* 1. Name

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* 2. Phone Number

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* 3. Email Address

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* 4. You are

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* 5. What activities would you most likely to participate? (select all that apply)

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* 6. How often would you participate?

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* 7. When are you likely to participate 

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* 8. Would you be interested in leading or planning an event, activity or program with the help of the Director of Youth and Young Adults

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