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IMPORTANT COVID 19 UPDATE AND ACKNOWLEDGEMENT
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Please note that, due to the recent "stay at home" order, we may not be able to ship kits or bras out. We will do our best to address all requests on a case by case basis once the order is lifted. Should you have any questions at all, please do not hesitate to contact us. Please check the box to verify you have read and understand. Our wishes and prayers for safety and health while we navigate this difficult time.
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Name
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First Name
Last Name
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Delivery Address
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Address Line 1
Address Line 2
City
State
Zip
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Email
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Phone
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Date of Birth
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Date of first treatment
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How did you hear about us
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Acknowledge
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I understand that Pink Warrior Angels Hill Country will keep my information confidential, but that it may be shared with members of the Board of Directors.
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Please confirm
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Our goal is to ensure kits are delivered to women currently facing breast cancer. Please confirm this kit is being sent to someone who is currently facing this diagnosis.
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