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* 1. Full Name

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* 2. Email address

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* 3. Phone number

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* 4. In which neighbourhood or municipality do you live? (i.e., Esquimalt, Fernwood)

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* 5. Tell us about yourself through a brief bio (approximately 250 words).

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* 6. Why are you interested in joining the committee?

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* 7. Any additional details you wish to include?

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