Presenter Information

Important: write your Name, Title, and Organization exactly the way you want it to be read on your name tag and in the convention program.

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* 1. Name

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* 2. Title

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* 3. Organization

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* 4. Your Address

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* 5. Work Phone

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* 6. Cell Phone

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* 7. E-Mail

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* 8. Emergency Contact Name and Number

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* 9. In 100 words or less please enter a short biography

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* 10. Please Upload Your Photo

JPEG, JPG file types only.
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