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Vallarta Gay+ Community Center
Contact & Registration Form
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Full Name
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Nombre Completo
Your answer
Whatsapp
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Phone Number
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Email
Correo Electronico
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Servicio que necesito / Service(s) I need
PrEP (Existing SETAC patient / Paciente existente de SETAC)
PrEP (New patient / Nuevo paciente)
STI Testing / Pruebas de ITS
STI Treatment / Tratamento de ITS
Other:
Want to help? / Gustas ayudar?
I would like to donate / Me gustaria donar
I would like to volunteer / Me gustaria ser voluntario
I would like to work for the organization / Me gustaria trabajar para la organizacion
Other:
Comments / Comentarios
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Stay In Touch / Mantenme en contacto
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