Name or Name of Organization

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* 1. Name or Name of Organization

If this is an organization, how many members are interested in volunteering?

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* 2. If this is an organization, how many members are interested in volunteering?

Email

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* 3. Email

Phone Number

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* 4. Phone Number

Are you or your organization's members located in Georgia?

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* 5. Are you or your organization's members located in Georgia?

If yes, in what county/counties are you or your organization's members located?

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* 6. If yes, in what county/counties are you or your organization's members located?

If no, in what state are you located?

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* 7. If no, in what state are you located?

Skills/Certifications

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* 8. Skills/Certifications

Start Date?

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* 9. Start Date?

End Date?

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* 10. End Date?

Area of volunteer interest

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* 11. Area of volunteer interest

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