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* 1. First Name

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* 2. Last Name

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* 3. Designation

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* 4. Position on the Board of Directors

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* 5. Email Address

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* 6. Cell Phone Number

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* 7. Mailing Address

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* 8. Why are you interested in attending the AAFP Annual Chapter Leadership Forum?

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* 9. Please submit your current CV (3 page max if possible) or email it to Kaitlin McGuffie at kmcguffie@ohioafp.org

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