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* 1. Please enter your full name

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* 2. Please enter the name of your Co-op or organization

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* 3. How many people will be attending including yourself?

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* 4. Please indicate in appropriate age/gender box how many children (under 15) will be attending. If none, enter 0 in appropriate box.

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* 5. Please provide an email address where you can be reached

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* 6. Please provide a telephone number where you can be reached

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