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Sue and George Sergenat

Wednesday, May 19, 2021
8:00 AM 10:00 AM 08:00 10:00

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Date and Time

5/19/2021 from 8:00 am - 10:00 am

Name

First Name

Last Name

Email

Number of Counters

Address

Mailing Address (Please share if you don't yet receive mail from KELT. We would love to send you a thank you letter for counting!)

Address 1

Address 2

City

State/Province

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Country

Phone

Phone Number (In case we need to get in touch with you about updates for the count)

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