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Contact Information
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Salutation

Your First Name:

Your Last Name :

First Name
of the person you are writing about: *

Last Name
of the person you are writing about: *

Your E-mail Address: *
Confirm E-mail: *
Age of Person this Concerns: *
Relationship to that Person: *
Street Address line one:
Street Address line two:

City: *
State/Province: *
Country: *
Zip/Postal Code: *
Daytime Phone:
Evening Phone:
Mobile Phone:
Timezone
Problem or Issue
Letl us know what's going on.
Are you in a safe place? Yes   No
Do you want to remain anonymous? Yes   No
Tell us know what's wrong
Your Concern
Tell us what's going on:
You may write as much as you like.
 
Recipient Information
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I would like Hunter to respond Yes   No   Doesn't Matter
Email a confirmation Yes   No
  

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