Freshwater Symposium Registration 2022

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* 1. Name (First, Last)

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* 2. Preferred Pronouns

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* 3. Name as you would like it to appear on nametag

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* 4. School/Organization

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* 5. Address

Street

City/State

Zip Code

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* 6. Work Email

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* 7. Home Email

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* 8. Cell Phone

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* 9. Are you a formal (classroom) teacher?

Yes

No