* 1. What is your last name?

* 2. What is your first name?

* 3. What is your email address?

* 4. What is your institutional affiliation?

* 5. With what department are you affiliated?

* 6. What is your status?

* 7. What are your research interests?

* 8. What is your ethnicity (optional)?

* 9. What is your gender? (optional)

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