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1.
Contact Name:
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2.
Telephone #:
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3.
E-mail Address:
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4.
Organization(s) you are representing?
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5.
May we contact you for more information about your story?
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6.
Can we use your name when sharing your story or would you prefer to stay anonymous?
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Yes! Please use my name when sharing my kindness story!
No, I wish to remain anonymous.
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7.
Your Kindness Story...
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8.
Would you like to receive electronic updates about Random Act of Kindness Day?
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