AEOP Ambassador Program Registration

Yes! Sign me up. I understand that by completing the information below, I will be contacted from time to time with opportunities for participation in official AEOP Membership events. I also understand that if I am under 18 years of age, my parents must complete the final section of this form.

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* 1. What's your first name?

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* 2. What's your last name?

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* 3. What's your birthdate?

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* 4. What's your email address?

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* 5. What's your street address?

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* 6. In which city do you live?

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* 7. And in which state?

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* 8. What's your Zip code?

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* 9. In which AEOP sponsored programs have you participated? (Mark all that apply)

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* 10. In which AEOP Membership activities are you most likely to participate? (Mark all that apply)

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* 11. Are you currently under 18 years of age?

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* 12. PARENT/GUARDIAN: Please enter your first name:

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* 13. PARENT/GUARDIAN: Please enter your last name:

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* 14. PARENT/GUARDIAN: Please enter your email address:

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* 15. PARENT/GUARDIAN: By indicating YES below, I give my minor child permission to receive communications from AEOP Membership and the AEOP Alumni Association, and to participate in sponsored activities. I understand that because my child is a minor, a parent or guardian will need to accompany them to any planned events.  I further understand that AEOP Membership will send me an email confirming my child's status in the program and that I am required to respond to complete registration. Finally, I understand that I may direct any questions I may have now or in the future to the Director of AEOP Membership, Dr. Gregory E. Stone, at gregory@metriks.com.

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