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* 1. Full Name

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* 2. Proposing Organization

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* 3. Position

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* 4. Email

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* 5. Office Phone

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* 6. Cell Phone

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* 7. Brief biographical summary (maximum 200 words)

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* 8. Why you have an interest and willingness to participate in the Guanajuato Civic Leadership program (maximum 300 words)

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