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REGISTRATION FORM Full Name: DOB: Age: Gender:FM Emergency contact: Full address: PC: Cell / Home pH: Email: Do you give us permission to use your email for communications and important information:

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Contact Us - VAGov is a platform that allows individuals to reach out to state government services and provide necessary information or inquiries related to various governmental programs and services.

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Individuals or entities who need to communicate with the Virginia government for inquiries, requests, or reporting information may be required to file through the Contact Us - VAGov system.

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The purpose of Contact Us - VAGov is to facilitate communication between citizens and the state government, allowing users to seek assistance, report issues, or ask questions regarding government services.

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Individuals must report their contact information, the subject of their inquiry, a detailed description of their request or issue, and any supporting documentation if applicable.

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