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* 1. First and Last Name:

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* 2. Institution:

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* 3. Email Address:

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* 4. Work Phone:

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* 5. Address:

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* 6. City, State, & Zip Code:

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* 7. Is your institution an ASTC member?

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* 8. Please indicate the type of activity you are proposing.

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* 9. Please give a brief description of your demonstration or activity. We want to provide a diverse array of offerings for students.

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* 10. How long do you anticipate students will spend engaged with your activity or demonstration?

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* 11. How many six-foot tables will your activity require?

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* 12. How many chairs will you need?

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* 13. Will you require access to electricity?

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* 14. Will your activity require access to water?

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* 15. What is the height clearance required for your activity?

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* 16. Is there anything else organizers should know about your proposed activity?

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