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AAYHF Mental Health Training
Date
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Day
Year
Date
Name
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First Name
Last Name
Number in Household
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Income
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o - 20,000
20,001 - 50,000
50,001 - 80,000
80,001 - 100,000
100,001 +
Email
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Age
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Approved Media Release
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I certify that I receive the indicated income from the following source
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I am self-declaring my identity as proof of identification at this time
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What are you expecting to gain out of this class?
Training Dates You wish to Participate in: (Select All that applies)
May 18, 2023
June 7, 2023
July 18,, 2023
August 1, 2023
September 12, 2023
October 3, 2023
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