2. Do you accept the pledge to set the pace?

   1. I pledge to set the pace
4. First Name:*
6. Surname:*
8. Address:*
10. City:*
12. State:*
14. Zip:*
16. Email:*
18. Phone:
20. Please choose one of the following for your decal:*

    1. Sticker (static-cling)
    2. Magnet
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22. 1. Receive an email copy of this form.
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24. Submit Submit and Print

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