2. 
4. Kaunoa Newsletter "The Best Years"
   To have your name included on the mailing list for Kaunoa's monthly newsletter, The Best Years, please complete with the following information:
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Phone Number*
18. Second Phone Number
20. Birth Date (mm/dd/yyyy)*
21. Sex*
    -- Select One --MaleFemale
23. Email Address*
25. Emergency Contact*
    (name, relationship, daytime phone number)
27. How did you hear about Kaunoa?*
    -- Select One --Family/FriendInternetEmailBrochureFlyerPrevious CustomerPhonebookRadioTVSocial MediaOther

    Please select an option from the dropdown menu.

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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