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SNAP Online Community
We are so happy that you are interested in our online community, however, we would like to learn more about you. Please help us by completing this form, even if you are already a SNAP member.
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Name: Last, First
*
Your answer
Phone number (please tell us if it is your home or mobile number)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Address
*
Your answer
Email
*
Your answer
Emergency Contact (please provide at least one name and telephone number)
*
Your answer
Type of device you have at home
*
Desktop computer
Laptop computer
Tablet (Android)
I pad
Mobile phone
Do you have access to the internet?
*
Yes
No
Required
Are you currently a member of SNAP?
*
Yes
No
Required
If No, how did you hear about us?
Your answer
What classes/groups are you most interested in?
Exercise
Discussion groups
Special Events
Movie/Entertainment Night
Support Groups
All of the Above
Is there a class/group that you would like to see in the future?
Your answer
Are you comfortable having your photo on our social media sites?
Yes
No
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