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* 1. Last name

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* 2. First name

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* 4. Status

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* 5. Personal email address 

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* 6. Work email address

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* 7. Category

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* 8. COA membership number.

If you are unsure of your membership number and cannot access your profile, contact Membership at coamembership@coausphs.org. If your membership has lapsed you can renew at www.coausphs.org/join.

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* 9. How did you first hear about this event?

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* 10. What would you like to see offered at future COA Gatherings?

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