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Aktion Club Disaster Relief Project Completion Form
Complete the following to request the New York District Disaster Relief Project Banner Patch
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Email
*
Your email
Aktion Club Name
*
Your answer
Contact Name (First, Last)
*
Your answer
Street Address
*
Your answer
City, State, Zip
*
Your answer
Kiwanis Division
*
Your answer
Kiwanis Sponsor Club
*
Your answer
Phone number
Your answer
Number of Disaster Relief Kits Completed
*
Your answer
Date of Completion
*
MM
/
DD
/
YYYY
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