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Name of Organization/Company/School/Other
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What ages would participate in the program? (Please select all that apply)
Young Children (under the age of 12)
Older Children (between the ages of 13 – 18)
Young Adults
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Target dates to begin program?
What type of program are you most interested in?
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Other {comment box}
Not quite sure
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Where do you foresee this program taking place?
What else would you like us to know about your school/organization/company?
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