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2024 DWP CARES REGISTRATION
Please complete all section to be considered for acceptance into this years program
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REGISTRATION FEE. Once you have been accepted into the program you will receive an invoice for billing.
NEW CARES REGISTRATION PARTICIPANTS $1200
RETURNING CARES REGISTRATION PARTICIPANTS $850
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FIRST NAME
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LAST NAME
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DATE OF BIRTH
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YYYY
GENDER
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OTHER
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ADDRESS
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CITY
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STATE
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Zip Code
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COUNTRY
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PHONE NUMBER
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