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Check-In (Free Syphilis, HIV, and Hepa B Test): Pre-registration
This is the sign-up form for a free HIV, Syphilis, and Hepa B Test on July 22, 2012 (Sunday).
You will be receiving a confirmation message and event details after signing up.
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Name
*
Your answer
Mobile Number
*
Your answer
E-mail Address
*
Your answer
Would you like to be included in the regular mailing list of Love Yourself?
*
YES, I would like to receive communication on other HIV testing events and upcoming activities.
NO, please remove me from your mailing list after sending me the event details.
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