CARES for Youth Membership Interest Questionnaire
CARES for Youth requests the following information so we may provide you information and action updates related to our efforts to eliminate extreme sentencing for youth.
What is your first name? *
First name
Your answer
What is your last name? *
Last name
Your answer
What is your home address? *
123 Sycamore St.
Your answer
City? *
City
Your answer
State? *
State
Your answer
Zipcode? *
Zipcode
Your answer
Preferred contact phone number
(xxx) xxx-xxxx
Your answer
Alternate contact phone number
(xxx) xxx-xxxx
Your answer
Do you have an email address? *
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