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* 1. Name and pronouns:

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* 2. Contact information:

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* 3. Class/position:

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* 4. Which workshop(s) would you be interested in learning how to co-facilitate?

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* 5. Identities (used in arranging the Coming Out presentations):

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* 6. What intersections with your sexual orientation and/or gender identity would you like to speak about (used in arranging the Coming Out presentations)?

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* 7. Do you have a preference for the audience(s) to which you would like to present?

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* 8. Travel questions:

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* 9. Is there anything else you would like the Speaker's Bureau Coordinator to know?

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