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Give Back a Smile Laboratory Fundraiser Pledge Form Thank you for participating in the Give Back a Smile (GAS) lab fundraiser! All proceeds support survivors of domestic and sexual violence to receive
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How to fill out Give Back a Smile:

01
Visit the official website of Give Back a Smile.
02
Locate the registration form on the website and click on it.
03
Fill out all the required fields in the registration form accurately.
04
Provide personal information, including your name, contact details, and address.
05
Answer any additional questions or provide any necessary supporting documents as requested.
06
Double-check all the information you have provided to ensure it is accurate and complete.
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Submit the filled-out registration form online by clicking the "Submit" button.
08
Wait for a confirmation email or notification from Give Back a Smile regarding the status of your application.
09
Follow any further instructions provided by Give Back a Smile to complete the application process.

Who needs Give Back a Smile?

01
Individuals who have experienced dental injuries resulting from domestic violence.
02
Survivors of sexual assault or human trafficking who require dental restoration.
03
Individuals who have suffered dental injuries due to acts of crime or accidents.
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Give Back a Smile is a program that helps survivors of domestic violence and/or sexual assault by providing free dental care treatment.
Survivors of domestic violence and/or sexual assault who are in need of dental care treatment are required to file for Give Back a Smile.
To fill out a Give Back a Smile application, survivors can visit the program's official website and follow the instructions provided.
The purpose of Give Back a Smile is to help survivors of domestic violence and/or sexual assault rebuild their confidence and self-esteem through free dental care treatment.
Applicants must report their personal information, details of their domestic violence and/or sexual assault experience, and their dental care needs.
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