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2. First Name*
3. Last Name*
5. Email Address*
7. Why would you like to be part of our Agawam Family Challenge?*
9. How often does your family exercise per week? What activities do they participate in?*
11. Are you willing to write a blog 2 times per week about your experience if you are chosen?*

    1. Yes
    2. No
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13. 1. Receive an email copy of this form.
14. Email address

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15. Submit

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