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FORM 2: LAC Facilitator Information Sheet

This form should be accomplished by the designated LAC Facilitator on or before the first LAC
session.

Region: VI

Division: ILOILO

NAME: Male/Female: Date of Birth: Age:


APRIL VISIA S. SITIER- FEMALE April 12, 1990 30
BRAZAS

Contact details: Email: Mobile Number: Facebook Name:


Visia12april@gmail.c 09302086976 April Vish
om

Preferred contact (Indicate all: email, phone, Skype, Viber, WhatsApp, Zoom,
mode: Googlemeet, FB, Messenger, etc.)

Gmail account visia12april@gmail.com

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