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Registration (Registrio)
Thank you for submitting your information. A staff member will be contacting you over the phone to provide you with a Client ID Number.
Gracias por submitir su información. Un miembro de nuestro equipo se contactará con usted por telefono para proveerle su número de cliente.
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Language Preference
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English
Spanish
Portuguese
Creole
Ukrainian
Russian
Polish
Arabic
Other:
What brought you to our food bank for the first time today? (Select all that apply)
¿Qué le trajo a nuestro banco de alimentos por primera vez hoy? (Seleccione todas las opciones que apliquen)
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Changes or delays in government assistance/benefits (e.g., SNAP, Medicare, unemployment) - Cambios o retrasos en la asistencia/beneficios del gobierno (p. ej., SNAP, Medicare, desempleo)
Job loss or reduced work hours - Pérdida de empleo o reducción de horas de trabajo
Low wages/Not enough income to cover expenses - Bajos salarios/Ingresos insuficientes para cubrir los gastos
Rising cost of groceries and/or other living expenses (rent, utilities, etc.) - Aumento del costo de los alimentos y/u otros gastos de vida (alquiler, servicios públicos, etc.)
Unexpected bill or emergency expense (medical, car repair, natural disaster, etc.) - Gasto inesperado o de emergencia (médico, reparación de coche, desastre natural, etc.)
Family or household changes (new baby, divorce, increased caregiving) - Cambios en la familia o el hogar (nuevo bebé, divorcio, aumento de responsabilidades de cuidado)
Referred by another community organization or individual - Referido por otra organización comunitaria o individuo
Other:
Required
Last Name (Apellido)
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Your answer
First Name (Nombre)
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Your answer
Address (Dirección)
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Your answer
Phone Number (Número de teléfono) (Please use hypen: ###-###-####)
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Your answer
Email
Your answer
How did you hear about AFFB's online registration?
Your answer
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