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State Facilitator
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1
Welcome. What is your first name?
*
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(Your First Name)
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2
Are you willing to be a State Facilitator
YES
NO
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3
{name}, what is your last name?
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4
What state are you in?
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5
What county are you in?
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6
Thank you {name}. What is your email (we will not spam you)
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example@example.com
Confirm Email
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7
Phone number (Our emails get censored - we will text you the link (We will not spam you)
Please enter a valid phone number.
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8
If you have any questions or comments, please type them here.
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