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Community Events Program
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Email Address
*
Your answer
What Community Program Event is this for?
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Exer Sports and Schools
Boy Scouts of America
Girl Scouts of America
School or Troop name (Must be proper, full name. NO ABBREVIATIONS. Don’t get this wrong.)
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Your answer
In what city is your School or Troop located?
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Your answer
Exer Clinic Location(s)
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Your answer
Event Date(s)
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Your answer
Event Start / Finish Time
Your answer
Patient Appointment Time Slots
*
Example: 2 slots every 15 mins
Your answer
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