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* 1. Will you be attending this event?

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* 2. First name

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* 3. Last name

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* 4. What is your title?

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* 5. What is your institution?

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* 6. What is your street address?

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* 7. In what city do you live?

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* 8. State?

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* 9. Zip?

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* 10. Country?

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* 11. Do you have any dietary or disability requirements we should be aware of?

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* 12. Do you have any specific topics you would like to discuss?

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* 13. Will you need a hotel room?

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* 14. For which nights?

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* 15. We will be sharing attendee information online. If you would like your name withheld, please check here.

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