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* 1. First Name

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* 2. Last Name 

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* 3. Institution

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* 4. Email 

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* 5. Presentation Title

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* 6. Please provide a short summary of your presentation (<200 words)

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* 7. Please provide a short professional bio (<100 words)

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* 8. Rough availability, please include all upcoming months it would be ideal for your schedule to present (select all that apply)

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