| Name |
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| Date |
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| Address |
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| Phone |
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| Represents (self or name of organization) |
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| Choose 1 |
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| Choose 1 |
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| Title |
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| Author |
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| Publisher |
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What, specifically, do you object to in this material?
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What do you feel might be the result of reading this material?
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What parts of the material do you consider valuable?
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Did you read/listen to the entire material?
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What do you believe the theme of this material is?
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| |
