Thank you for collecting phones for NCADV!
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| Name
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| Organization or Company
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| Shipping Address (Street Addresses only. No PO boxes.)
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| Email address:
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| Please confirm: Email address:
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| Phone Number
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| How did you hear about this program?
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| How many cell phones are you hoping to collect and ship?
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| Is this an on-going or one-time collection?
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| On-going collection One-time collection
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| Is this a multi-site collection?*
| Yes No *Will this collection be held in multiple buildings/locations?
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If you answered "yes" above, how many locations?
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| Will you need collection boxes for your efforts?*
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| No, I plan to use my own Yes, please ship me boxes *NCADV will determine the number of boxes needed based on your estimate of how many cell phones you aim to collect, if your collection will be held in multiple locations or if it is an on-going collection. Please allow two-weeks for box delivery.
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Image Verification
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