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Name
Whats Your Roll
I'm an Athletic Director
I'm an Athletic Trainer
I'm a Team/League President/Administrator
I'm a High School/College Coach
I'm a Club Coach
I'm a Youth Coach
I'm a Parent
I'm a Grandparent
Other
Other Roll
Phone
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Email
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Type of Organization
League
Club Team
Academic Institution
League Name
Club Team Name
Academic Institution Type
College/University
High School
Middle School
Elementary School
Other
School Name
Sport
American Football
Soccer/Football
Flag Football
Hockey
Field Hockey
Rugby
Lacrosse
Gymnastics
Cheerleading
Boxing
Surfing
Cycling
BMX
Baseball
Softball
Basketball
Wrestling
Vollyball
Water Polo
Equestrian
Polo
Other
Other Sports
Address
City
State / Province / Region
ZIP / Postal Code
Age of League Participants
Youth (6 - 15)
High School (15 - 18)
18+
Amount of Players
Are you currently using a concussion management tool in your league? If yes, please describe your experience.
How did you hear about us?
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Convention/trade show exhibit
News articles/medical journal
Used in a previous organization
Other
Phone
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