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This form is a demo and may not be submitted by anyone other than the creator of the form.
Captcha
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What is 2 + 5?
Your Name
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Your phone number
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Your email address
We value your privacy and will not share this with anyone.
Your badge number
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Date incident occured
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Month
Month
Jan
Feb
Mar
Apr
May
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Jul
Aug
Sep
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Dec
Day
Day
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31
Year
Year
2023
2024
2025
2026
2027
Do you know approximately what time the incident occured?
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Yes
No
Approximate time the incident occured
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Hour
hour
1
2
3
4
5
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7
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9
10
11
12
:
Minute
minute
00
01
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59
am
pm
Where incident occured
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Select a location
Club entrance (gate)
Clubhouse
Archery range
Indoor range
Outdoor range
Trap range
Multiple, or other location (please describe below)
Description of incident
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Please be as descriptive as possible, including any names, badge numbers or license plates.
