Contact Information

First Name:

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* 1. First Name:

Last Name

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* 2. Last Name

What institution do you represent? (Name of School, Library, Company, etc.)

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* 3. What institution do you represent? (Name of School, Library, Company, etc.)

What type of institution do you represent?

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* 4. What type of institution do you represent?

E-mail Address:

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* 5. E-mail Address:

Phone:

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* 6. Phone:

How would you rate your level of experience with E-rate?

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* 7. How would you rate your level of experience with E-rate?

Do you intend to apply for Category 2 equipment funding for FY 2018?

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* 8. Do you intend to apply for Category 2 equipment funding for FY 2018?

What is your biggest E-rate concern/question that you would like addressed at training?

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* 9. What is your biggest E-rate concern/question that you would like addressed at training?

Please certify to the following:

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* 10. Please certify to the following:

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