Please complete the information requested below to help us understand where you are located and what volunteer activities you are most interested in.  You will be contacted once responses have been collected.  Thank you in advance for your help in making medical aid in dying a legal option in Arizona!

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* 1. Contact Information

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* 2. If you live in Arizona, which city are you closest to? (we have different needs in different parts of the state)

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* 3. Please check the area(s) below that you would like to volunteer in (note:  you will be contacted to discuss specific volunteer opportunities)

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* 4. Everyone's contribution is important.  We may have some specific needs in the areas below, so please indicate if you have experience you can share

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* 5. Comments

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