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First Name
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Last Name
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Email Address
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Demographics
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Children
Age 0-4
Age 5-9
Age 10-14
Age 15 - 19
Adults
Age 20-24
Age 25-29
Age 30-34
Age 35-39
Age 40-44
Age 45-49
Age 50-54
Age 55-59
Age 60-64
Age 65-69
Age 70-74
Age 75 - 79
Age 80-84
Age 85-89
Age 90-94
Age 95+
Date of Birth
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Mobile Number
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Home Address
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What service or event do you attend at WPCBC?
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AM Service
PM Service
Seniors Morning Tea
Window for Widows
Bible Growth Group
Other
If other - please list
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