Thank you for your interest in joining a Walk for Apraxia planning team! Please complete the following survey and a representative of Apraxia Kids will be in touch.

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* 1. First Name

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* 2. Last Name

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* 3. Email Adress

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* 4. Phone Number

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* 5. City

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* 6. State

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* 7. Have you previously attended a Walk for Apraxia?

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* 9. What are your areas of interest/skill? (check all that apply)

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* 10. Is there any additional information that you would like to share?

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