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Please feel free to share
your problem/ crisis more clearly to enable us to extend all possible
help at the earliest. Please note that this is a voluntary service
and not for any profit. Your information would be kept confidential.
Pl. complete this questionnaire
and send this by email (copy and paste)
1. Your name in Full:
2. Your age & Sex :
3. Describe your problem/ Crisis:
4. Your full postal address:
5. Telephone no. & Email address:
6. What kind of help you need / want? :
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