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Heart to Heart Circle of Life
Friends & Partners
Event Sponsors & Supporters
PowerUp Foundation Event Waiver
Please fill out the following form
in order to participate in our activity.
Date of Birth
Type Full Name Here
1. I am the applicant , or an officer of the applicant, for a permit to conduct or hold a demonstration, as defined in the document entitled "City of
If you answered yes to any question, please elaborate
I declare that the info I’ve provided is accurate & complete
Thanks for submitting!
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