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Fill Out This Form To Participate in the 2003 Diabetics/Disabled Anonymous
TASK FORCE!!!

How I am affected by changes in MINNESOTA DHS Laws 2003

What is your name?


What is your email address?

Address:

ZIP:

Phone:

Fax:

WE NEED THE FOLLOWING Task Force Info:

SPECIFICS ON HOW YOUR ARE AFFECTED AND ... 

 Write in information about yourself, your problems, and needs, in this box (You may also list links and feedback here);-

Please give your age, nationality, educational history, other relevant histories and and full descriptions of any other pertinent information:

 


 

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THIS SITE IS: DDA
www.MurderbyDiabetes.org
www.DDAexchange.org