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Ng you to provide the information on this form under USC, Chapter 5, Section 521 and Chapter 17, Section 1710. VA may disclose the information that you put on this form as permitted by law. VA may make a "routine use" disclosure of the information as outlined in the Privacy Act systems of records notices identified as 121VA19 National Patient Databases - VA . Providing the requested information is voluntary. However, you will not be able to participate in the event without furnishing this i.

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