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Dose of Prevention Award Application Form
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Name:
*
Organization:
Address:
Phone:
E-Mail:
Is Your Organization a CADCA member in good standing?:
Yes
No
Please describe what your organization did to raise awareness about over-the-counter cough medicine abuse (Max. 250 words). :
What impact have your efforts had on your community (Max. 200 words):
Why should your organization win the Dose of Prevention Award (Max. 200 words)?:
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