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2. 
4. Please choose one:*

   1. I am new to the WIC Program and would like to apply.
   2. I am currently a WIC participant (or have been in the past) and would like to schedule an appointment.
6. First Name*
8. Last Name*
10. Phone Number*
12. WIC staff will contact you within the next business day. WIC hours are Monday – Thursday 7:30am – 5:00pm.
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14. 1. Receive an email copy of this form.
15. Email address

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16. Submit

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