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* 1. Name

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* 2. Have you ever donated time to a community wellness event, a health care initiative or human service project?

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* 3. Would you share your volunteerism with the Hospital and the community?

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* 4. Please describe the type of service completed?

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* 5. Where was the service provided?

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* 6. Description of Tasks:

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* 7. Can you estimate the time you spent on this effort?

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* 8. How many of your family, associates or friends helped you with your efforts?

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* 9. Can you estimate the time spent by your family, friends and associates on this effort?

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