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If you have received this form it is because you are an individual that we'd love to have at the table as we seek to combat father absence and promote responsible fatherhood in our community.  

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* 1. General Information

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* 2. Do you have any dietary restrictions? (Select all that apply.)

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* 3. In what ways could you help promote responsible fatherhood in WNY.

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* 4. What sector of community life do you mostly identify with?

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