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* 1. Your Name:

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* 2. Your Email

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* 3. MDDC activity / event name that you participated, attended, or were affected by:

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* 4. When was the MDDC activity that you participated, attended, or were affected by?

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* 5. How did you learn of the availability of the program you are referring to?

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* 6. How many people in your family (including yourself) participated,
attended, or were affected by MDDC activities?

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* 7. What best describes who you are?

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* 8. Is there another MDDC event/activity that you participated in, attended, or were affected by?

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