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* 1. Please, provide us with your name and surname.

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* 2. Kindly provide us with your email address so we can get in touch with you.

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* 3. Please could you give us your contact number.

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* 4. Which affected area do you live in?

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* 5.  How has your home or business been affected?

*This initiative is funded by SweepSouth and to continue driving change and creating work opportunities, SweepStars will still earn their booking fee. 

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