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State and Local Concurrent Event Response Form

OFFICE FOR VICTIMS OF CRIME
2003 National Crime Victims' Rights Week
A Nation Unites for Victims' Rights
State and Local Concurrent April 10th Events

RESPONSE FORM

Name: (First, Middle. Last): __________________________________________________

Agency (if applicable): __________________________________________________

Title (if applicable): __________________________________________________

Mailing Address:

Street Address or Post Office Box : __________________________________________________

City, State, Zip Code: __________________________________________________

Area Code/Telephone Number: __________________________________________________

E-mail Address: __________________________________________________

Description of Concurrent April 10th Event (including specific jurisdiction, co-sponsors, etc.):

Please return this Response Form
no later than Friday, March 28,

to:

Office for Victims of Crime
Fax: 202-514-6383 or 202-305-2440

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State & Local Field Resource Package (2003) March 2003