*Please answer questions 1-3 as you would like it to appear on your name tag (to be distributed at the event).

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* 1. Title

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* 2. First Name:

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* 3. Last Name:

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* 4. What is your Institution?

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* 5. What is your e-mail:

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* 6. Field of study/major:

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* 7. Are you a student, a faculty or staff

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* 8. If a student, do you need a ride to the event?

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