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Virtual Swallowing Support Group: May 26th 12:00-1:00 pm CT
Registration for virtual support group
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Email
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Confirm Email Address
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Name
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First and Last
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Tell us about yourself
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Phone
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Address Where You Will Be Participating From
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Please Provide the Following: Street Address, City, State, Zip Code, Country
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Emergency Contact Name
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First and Last Name
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Emergency Contact Phone Number
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Consent
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I am an adult (18+) impacted by a swallowing disorder
I live in the US
I recognize this is not a replacement for medical advice
I am available for the entirety of the Virtual Support Group Meeting
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A copy of your responses will be emailed to the address you provided.
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