Community Care is glad that you are interested in helping to lead the way for our Youth Advisory Board. By answering the questions below, you are giving permission for someone at Community Care to contact you for further discussion and information.

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* 1. Name:

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* 2. County of residence:

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* 3. Best way to contact you (email, phone number to call or text, Facebook, etc.):

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* 4. Best times to contact you if phone is preferred:

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