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2. The Southampton Youth Bureau’s Youth Advisory Committee's Coupon Books

   Coupons will expire December 31, 2022

4. Contact Info will not be shared or Publish unless otherwise specified.
6. Business Name*
8. Contact Person's Name
10. Mailing Address
12. Business Address*
14. City*
15. State*
16. Zip Code*
18. Business Phone Number (will be shared)*
19. Email Address
21. Cell Phone Contact (will not be shared)
23. Specify Coupon Offer*
24. Specify Coupon Verbiage*
    Specify Business Name, Address, Phone Number, other pertinent info ie: hours of operation...
26. Upload Logo
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28. 1. Receive an email copy of this form.
29. Email address

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