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* 1. Name:

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* 2. Email Address/Phone Number

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* 3. Would you be interested in participating in online social recreation events vi zoom?

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* 4. Do you have internet access?

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* 5. Do you have a ___________________?

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* 6. What types of activities/topics would you be interested in? Check all that apply

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* 7. Once it is safe to do so would you be interested in participating in social recreation events in person?

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* 8. Do you have any other suggestions?

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* 9. Would you be interested in being part of an adult council with SCIL staff to plan out events/activities throughout the year?

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