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D&B Participant Registration (2024)
Thank you for joining us for Snorkel Day! This form is good for the 2024 calendar year.
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* Indicates required question
Snorkel Day Location
*
Kona
Hilo
Kawaihae
Full Name
Your answer
Birth date
*
MM
/
DD
/
YYYY
Address
*
Your answer
Phone number
*
Your answer
Email
*
Your answer
Residency
*
Full-time Hawaii Resident
Part-time Hawaii Resident
Visitor to the Islands
Ethnicity (One or more categories may be selected)
*
Hawaiian
Pacific Islander
Caucasian
Asian
Other:
Required
I will be attending the event with the following group: (e.g. Private Home/ UofN/ Full Life)
*
Your answer
Please list the caregiver(s) here with you today:
Your answer
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