| First Name * First Name |
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| Last Name * Last Name |
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| Address Line 1 * Address Line 1 |
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| Address Line 2 Address Line 2 |
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| City * City |
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| State/Province * State/Province |
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| Zip Code/Postal Code * Zip Code/Postal Code |
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| DayPhone * DayPhone |
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| Is this your * Is this your |
Home |
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Work |
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Cell |
| Evening Phone Evening Phone |
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| Is this your Is this your |
Home |
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Work |
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Cell |
| EMail * EMail |
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| How would you like to be contacted? How would you like to be contacted? |
Email |
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Day Phone |
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Evening Phone |
| Gender Gender |
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| I am interested in the following sport * I am interested in the following sport |
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| Select an information meeting to attend
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Meetings Available in your Area:
| Tue,02-02-10, 6:00PM
Fundraising Clinic
Regence
100 SW Market St
Portland,OR,97201
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| Wed,02-03-10, 6:00PM
Coffee Talk - Last Chance Meeting
Starbucks
11405 SW Beaverton Hillsdale Hwy
Beaverton,OR,97005
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| Thu,02-04-10, 5:30AM
Coffee Talk - Last Chance Meeting
Starbucks
4633 NE Fremont St
Portland,OR,97213
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| Sat,02-06-10, 8:00AM
Try A Training
Portland Area
Locations Vary By Sport
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| Select an event you are interested in Select an event you are interested in |
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| Are you planning on Bringing a friend? Are you planning on Bringing a friend? |
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| If yes, what is your friend's name? If yes, what is your friend's name? |
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If you received a mailing about Team In Training, please provide us with the following information from the mailing label:  |
| Participant Code (found in top left corner of mailing label) Participant Code (found in top left corner of mailing label) |
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| Source Code (found in top right corner of mailing label) Source Code (found in top right corner of mailing label) |
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| Are you a TNT Alumnus? Are you a TNT Alumnus? |
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| What was the primary way you heard about Team In Training? * What was the primary way you heard about Team In Training? |
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| If you heard about Team In Training through one of our corporate sponsors or partners, which company was it? |
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| I am an employee of this company's national team I am an employee of this company's national team |
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| I am interested in becoming an advocate for The Leukemia & Lymphoma Society I am interested in becoming an advocate for The Leukemia & Lymphoma Society |
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| I am interested in starting a Friends/Family/Corporate Team. I am interested in starting a Friends/Family/Corporate Team. |
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| Comments |
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| The Society respects your privacy |