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* 1. Name:

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* 2. Job title:

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* 3. Academic Institution:

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* 4. Address 1:

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* 5. Address 2:

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* 6. City:

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* 7. State:

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* 8. Postal code:

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* 9. Email address:

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* 10. Phone:

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* 11. Please provide your answer to the following question in 300 words or less:

How will attending this conference benefit your institution and you professionally? Your answer should include the following:

• What are your goals for attending the conference?

• How this conference may benefit your institutions use and respect of intellectual property?

• Explain your financial need in applying for this scholarship?

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