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* 1. First Name

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* 2. Last Name

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* 3. Current Employer or University Program

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* 4. Address

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* 5. Email

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* 6. Cell Phone

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* 7. Will you be attending the upcoming TSHA Annual Convention and Exhibition?

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* 8. Field

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* 9. Job Setting Desired

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* 10. University/College (Undergraduate)

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* 11. Degree

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* 12. University/College (Graduate)

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* 13. Other Degree

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* 14. Date Degree Was/Will Be Obtained

Date

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* 17. Describe Work Experience

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* 18. Title of Position Desired

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* 19. Date Available to Begin

Date

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* 20. Geographical Preference [1]

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* 21. Geographical Preference [2]

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* 22. Please input your full name as an e-signature for confirmation of accuracy and completion

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* 23. Please upload a current copy of your CV or resume. If you do not upload it at this time, TSHA will reach out prior to the next Annual Convention and Exhibition to collect this information.

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