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Neighbor Kits Registration
Contact Information
First Name
Last Name
Email
Street Address
City
State
Zip Code
Kit Registration
Expected shipping date
How many of the following kits do you plan on assembling?:
Youth Mentorship Neighbor Kit
Home and Kitchen Neighbor Kit
Health and Wellness Neighbor Kit
I estimate the fair market value of this contribution to be (item's value + any gift card's value):
If you included gift cards please enter the sum of their value here:
LIRS Advocacy
