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Champions Social Programs Survey
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Cell Phone
*
Your answer
Zip code
*
Your answer
Nearest Islamic Center to you
Your answer
Where do you suggest going for our upcoming local trips?
Your answer
If we arrange a trip to Masjid Aqsa, would you want to join?
*
Yes
No
Maybe
Which dates do you prefer?
*
Thanksgiving Break 2022 (Nov)
Winter Break 2022 (Dec: would be more expensive)
Spring Break 2023 (March)
Other:
Required
Any suggestions or comments?
Your answer
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