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Please fill out our registration so we know how we can best serve you!
Family Mankind Registration Form
Full Name (First and Last):
Address: (City, State, Zip Code)
Preferred Method(s) of Contact:
Best Times to Call:
What is your race?
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Two or More Races
What is your household income?
$0 - $80,000
How did you hear about us? / How were you referred to Family Mankind?
When are you available to be counseled or participate in a group setting? (optional)
Thank you for joining!
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