Youths Against Domestic Violence Coalition

Member Questionaire

First Name

Last Name

M.I.

Ethnicity

Gender

Age

@

Email address

Password

max 20 characters

Mailing Address

State

zip code

-

City

What are your feelings about Domestic Violence ? (100 words or less)

Why do you want to join Y.A.D.M.?
(Youth Against Domestic Violence)

What do you think should be done to try to end domestic violence?

What role do YOU want to play in aiding the domestic violence epidemic?

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