This survey contains 10 questions and will take no more than 5 minutes to complete. We will contact you shortly once we receive your response. Thank you!
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* 1. Name

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* 2. Phone Number

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* 3. Email 

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* 4. Which UNA neighbourhood do you live in?

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* 5. What services do you need? (Check all that apply)

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* 6. What activities are you interested in? (Check all that apply)

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* 7. What is your preferred platform for us to lead seniors programming? Choose 

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* 8. How did you hear about this UNA Senior's Initiative, or other senior's work happening within the UNA?

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* 9. If you require service in a language other than English please state the language here:

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* 10. Comments (please provide any additional information you wish to share.

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