Distance Clinic Community Outreach
Sign up and Consent form for Wongu's Distance Community Outreach
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Email *
Name *
By checking yes, I am aware that the presentation may be recorded and used for marketing purposes for Wongu in the future. I understand that my voice and likeness may be on the recording. *
Required
By checking yes, I agree to act professionally and appropriately during the presentation. I give Wongu the right to remove me from the call at their discretion. *
Required
A copy of your responses will be emailed to the address you provided.
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